C) Membranous glomerulopathy
Correct ans is C) Membranous glomerulopathy
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This patient has a nephrotic syndrome, characterized by generalized edema and marked proteinuria (>3.5 g/day). Membranous glomerulopathy is the second most common cause of nephrotic syndrome in adults. (The most common cause is focal segmental glomerulosclerosis.) Up to 85% of cases are idiopathic.
The remainder occur secondary to the following:
*Systemic diseases - diabetes mellitus, solid tumors (lung and colon), and immunologic disorders (such as SLE)
*Certain drugs - gold penicillamine, and NSAIDs (drahmednawaz mentioned above)
*Infections - hepatitis B, hepatitis C, malaria, and syphilis
This patient's nephrotic syndrome and his underlying malignancy suggest membranous glomerulopathy. The microscopic findings presented are consistent with this diagnosis: uniform, diffuse thickening of the glomerular capillary wall on light microscopy. Electron microscopy reveals that this thickening is caused by irregular, dense deposits laid between the basement membrane and the epithelial cells. These protrusions resemble "spikes" when stained with silver. Immunofluorescence microscopy reveals that these granular deposits contain immunoglobulins (IgG) and C3.
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Correct ans is C) Membranous glomerulopathy
click image to enlarge
This patient has a nephrotic syndrome, characterized by generalized edema and marked proteinuria (>3.5 g/day). Membranous glomerulopathy is the second most common cause of nephrotic syndrome in adults. (The most common cause is focal segmental glomerulosclerosis.) Up to 85% of cases are idiopathic.
The remainder occur secondary to the following:
*Systemic diseases - diabetes mellitus, solid tumors (lung and colon), and immunologic disorders (such as SLE)
*Certain drugs - gold penicillamine, and NSAIDs (drahmednawaz mentioned above)
*Infections - hepatitis B, hepatitis C, malaria, and syphilis
This patient's nephrotic syndrome and his underlying malignancy suggest membranous glomerulopathy. The microscopic findings presented are consistent with this diagnosis: uniform, diffuse thickening of the glomerular capillary wall on light microscopy. Electron microscopy reveals that this thickening is caused by irregular, dense deposits laid between the basement membrane and the epithelial cells. These protrusions resemble "spikes" when stained with silver. Immunofluorescence microscopy reveals that these granular deposits contain immunoglobulins (IgG) and C3.
click image to enlarge
