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Currently filtering by tag: Subepithelial deposits

Art of Medicine: Membranous Glomerulopathy

The painting above depicts membranous glomerulopathy.   A single glomerular capillary loop with confluent subepithelial and intramembranous electron dense deposits along the glomerular basement membrane is shown.  Podocytes are showing foot process effacement and microvillous transformation, which results in loss of the filtration barrier leading to nephrotic syndrome.  An electron micrograph from a patient with membranous glomerulopathy is shown below. Membranous glomerulopathy is the second most common cause of nephrotic syndrome in adults.  A majority of cases are considered primary with autoantibodies directed against the podocyte antigens phospholipase A2 receptor (PLA2R, ~70% of cases) or thrombospondin type 1 domain containing 7A...

KDIGO Connections: Membranous Glomerulopathy

Welcome to the first post in our new series KDIGO Connections, a series in which we are asking our nephrologist colleagues to educate us in real-world experiences treating kidney disease. In this series, Dr. David Bourne will be kicking it off with KDIGO guidelines for a kidney disease in visual abstract form. Our hope is that these posts will foster discussion regarding these diseases and how different providers approach them. Please share any points, pearls, questions, caveats, thoughts, or experience you have on the presented disease letting us all learn from your experience!  

Resolving Membranous Glomerulopathy

A renal biopsy was performed on this 55-year-old female with a history of biopsy-proven membranous glomerulopathy status post immunosuppressive therapy, with a partial clinical response. The patient is currently being worked up for persistent subnephrotic proteinuria. This representative electron micrograph shows globally thickened capillary loops by a combination of intramembranous electron dense deposits completely surrounded by neomembrane (Ehrenreich and Churg stage III, blue arrow) and intramembranous electron lucent deposits with glomerular basement membrane remodeling (Ehrenreich and Churg stage IV, red arrow). These findings are compatible with a resolving membranous glomerulopathy. In light of these electron microscopy findings, the presence of...

Subepithelial Humps

The depicted electron micrograph shows numerous, large and irregular subepithelial deposits which protrude from the glomerular basement membrane towards the urinary space. The deposits are overlaid by significant epithelial foot process effacement and they lack definitive substructure. This type of deposits has historically been described as “hump-like”. While they are most commonly seen in the setting of infection-associated glomerulonephritis, they are by no means specific, and may be seen in other entities, such as C3 glomerulonephritis. When scarce, these deposits may be limited to the hinge region of the glomerulus. Over time, subepithelial hump-like deposits may become electron-lucent and eventually...