ATLAS OF RENAL PATHOLOGY
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MEMBRANOUS LUPUS NEPHRITIS
Pathology Editor: Agnes Fogo, MD
Medical Photographer: Brent Weedman
With Assistance From Kim Solez, MD, of the National Kidney Foundation's cyberNephrologyTM Team
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Fig 1. Membranous lupus nephritis,
with diffuse holes and small spikes visualized on the silver stain,
along with mild mesangial expansion with small areas of pink staining
in mesangial areas, indicative of mesangial deposits. Very mild
endocapillary increase of cells is also present, and occasional
subendothelial deposits were present by electron microscopy, indicating
a combination of lupus WHO Class V and very early proliferative
changes. This may be classified as lupus WHO Class Vc, or if light
microscopic changes warrant, combined WHO Class IV and V (Jones silver
stain; original magnification x400).
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Fig 2. Combined proliferative and
membranous lupus nephritis (WHO Class IV + V), evidenced by basement
membrane splitting, small spikes and holes in tangential sections, and
a small area of parietal epithelial cell proliferation and basement
membrane disruption, indicative of an early crescent formation (Jones
silver stain; original magnification x400).
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Fig 3. Immunofluorescence in
membranous lupus nephritis, WHO Class Vb, with diffuse granular
capillary wall and mesangial positivity (immunofluorescence with
anti-IgG; original magnification x400).
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Fig 4. Diffuse subepithelial dense
deposits and lesser mesangial deposits in this field in membranous
lupus nephritis. Reticular aggregates are also present in endothelial
cell cytoplasm in most cases of lupus nephritis (see Fig
9)(transmission electron micrograph; original magnification x8000).
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Fig 5. Combined proliferative and
membranous form of lupus nephritis, WHO Class IV and V, with massive
subepithelial and intramembranous deposits, frequent mesangial and
occasional subendothelial deposits and endocapillary proliferation,
distorting capillary loops (transmission electron microscopy; original
magnification x3,000).
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Fig 6. Close-up of subepithelial
deposits in lupus membranous glomerulonephritis, with well developed
spike formation and early basement membrane formation overlying some
deposits. This case was classified as WHO Class Vb (mesangial deposits
not shown in this micrograph). Two endothelial cells with well
developed reticular aggregates are shown in the middle of the field
(transmission electron micrograph; original magnification x10,000).
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From the Department of Pathology, Vanderbilt University Medical Center,
Nashville, TN.
Address author queries to Agnes Fogo, MD, Department of Pathology,
Vanderbilt University Medical Center, MCN C-3310, Nashville, TN 37232.
E-mail:Agnes.Fogo@vanderbilt.edu
Am J Kidney Dis 32(1):E1, 1998 (available www.ajkd.org)
Copyright © 1998 by the National Kidney Foundation, Inc.
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