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Pathology - Membranous nephropathy
Definition: A glomerulopathy characterized by widespread subepithelial immunological deposits within the glomeruli. Epidemiology: Rare occurrence.
Etiology • The majority of cases are idiopathic, with the immune complexes believed to form in situ. The antigen in these instances remains unidentified. Some cases are due to other illnesses, such as malignancies, pharmaceuticals, infections, and systemic lupus erythematosus (SLE). In these instances, the immune complexes likely originate elsewhere and flow to the kidneys, where they are deposited in the glomeruli.
Pathogenesis Immune complexes in the glomerulus compromise the normal filtration barrier, resulting in significant proteinuria. Presentation of nephrotic syndrome.
Light microscopy • All glomeruli exhibit thickened, rigid capillary loops. • Silver staining reveals 'holes' in the glomerular basement membrane, indicative of immune deposits, and 'spikes' that signify the glomerular basement membrane's response to these deposits. • More advanced cases may additionally demonstrate tubulointerstitial fibrosis. Immunofluorescence Granular deposits of IgG and C3 are, by definition, diffusely present along the capillary loops.
• The presence of deposits of IgA, IgM, and C1q necessitates consideration of membranous nephropathy secondary to systemic lupus erythematosus (SLE). Electron microscopy • Subepithelial electron-dense immune deposits are observed, accompanied by a variable response in the surrounding basement membrane. • Podocytes exhibit diffuse effacement of foot processes. Prognosis: Approximately one-third of patients have illness progression.
Definition: A glomerulopathy characterized by widespread subepithelial immunological deposits within the glomeruli. Epidemiology: Rare occurrence.
Etiology • The majority of cases are idiopathic, with the immune complexes believed to form in situ. The antigen in these instances remains unidentified. Some cases are due to other illnesses, such as malignancies, pharmaceuticals, infections, and systemic lupus erythematosus (SLE). In these instances, the immune complexes likely originate elsewhere and flow to the kidneys, where they are deposited in the glomeruli.
Pathogenesis Immune complexes in the glomerulus compromise the normal filtration barrier, resulting in significant proteinuria. Presentation of nephrotic syndrome.
Light microscopy • All glomeruli exhibit thickened, rigid capillary loops. • Silver staining reveals 'holes' in the glomerular basement membrane, indicative of immune deposits, and 'spikes' that signify the glomerular basement membrane's response to these deposits. • More advanced cases may additionally demonstrate tubulointerstitial fibrosis. Immunofluorescence Granular deposits of IgG and C3 are, by definition, diffusely present along the capillary loops.
• The presence of deposits of IgA, IgM, and C1q necessitates consideration of membranous nephropathy secondary to systemic lupus erythematosus (SLE). Electron microscopy • Subepithelial electron-dense immune deposits are observed, accompanied by a variable response in the surrounding basement membrane. • Podocytes exhibit diffuse effacement of foot processes. Prognosis: Approximately one-third of patients have illness progression.
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