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Case 156
Diagnosis
 
     
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Diagnosis: Residual Glomerular Changes of Glomerulonephritis or Previous Thrombotic Microangiopathy

In light microscopy there are minor changes: mild increase of the mesangial matrix and cellularity in some segments. Most relevant in this biopsy are some ultrastructural alterations in some segments of the capillary walls. In figures 9 and 11 there is irregular thickening of the GBM, suggesting a segmental double contour, without evident electron-dense deposits; in Figure 10 there is segmental loss of podocyte foot processes, and in Figure 12 there is subendothelial electron-lucent fluff of fibrillar finely granular amorphus material, with some electron-dense material that seems to correspond to detritus or remnants of organelles or cell membranes (?). These findings are nonspecific, but demonstrate residual changes from a previous process.

In the clinical context of the patient, with a history of previous nephritic syndrome, with low C3 serum levels at that time, indicate residual changes of previous glomerulonephritis. The negative IF demonstrates that there are no immune complexes or complement, highlighting the absence of activity at the time of the biopsy. Another possibility is that these findings are residual changes of an old thrombotic microangiopathy (TMA).

In conclusion: residual changes of glomerulonephritis or previous MAT.

See the chapter: Proliferative endocapillary glomerulonephritis of our Tutorial.

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References

  • Gunasekaran K, Krishnamurthy S, Mahadevan S, Harish BN, Kumar AP. Clinical Characteristics and Outcome of Post-Infectious Glomerulonephritis in Children in Southern India: A Prospective Study. Indian J Pediatr. 2015;82(10):896-903. [PubMed link]

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