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Diagnosis: Membranoproliferative glomerulonephritis

It is a difficult case. Based on morphology, we considered the possibility of membranous GN. However, hypocomplementemia, mesangial proliferation, and appearance of the IF for C3 strongly suggested type I membranoproliferative GN. Paraffin-embedded tissue was sent to another center for electron microscopy (EM), and from there reported "extensive electron-dense subendothelial deposits"; the case was diagnosed as type I membranoproliferative GN. We have no images of EM. The patient did not have signs of systemic disease.

For all these reasons we believe, after much discussion, and supported by the report of the EM, that this case is really a type I membranoproliferative GN.

There are very complicated cases such as this, where the diagnosis is very difficult. In the end, adding clinical morphology and IF we can get to "the better diagnosis".

See the chapter Membranoproliferative Glomerulonephritis of our tutorial.

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References

• Alchi B, Jayne D. Membranoproliferative glomerulonephritis. Pediatr Nephrol. 2010 Aug;25(8):1409-18. [PubMed Link] [Free full text link]

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