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).
 

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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