AJKD Atlas of Renal Pathology: Cryoglobulinemic Glomerulonephritis Agnes B. Fogo, MD, Mark A. Lusco, MD, Behzad Najafian, MD, Charles E. Alpers, MD  American Journal of Kidney Diseases  Volume 67, Issue 2, Pages e5-e7 (February 2016) DOI: 10.1053/j.ajkd.2015.12.007 Copyright © 2016 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Cryoglobulin-related glomerulonephritis (GN) with membranoproliferative pattern of injury. (A) Lobular appearance of the glomerulus with glomerular basement membrane double contours and subendothelial deposits seen as eosinophilic material. (B) Cryoglobulin-related GN with membranoproliferative features and cryoglobulin plugs (Jones silver stain). Panel A is reproduced with permission from AJKD 33(1):e1. American Journal of Kidney Diseases 2016 67, e5-e7DOI: (10.1053/j.ajkd.2015.12.007) Copyright © 2016 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Cryoglobulin-related glomerulonephritis with membranoproliferative features, and strongly periodic acid–Schiff (PAS)-positive cyroglobulin plugs within capillary loops (PAS stain). American Journal of Kidney Diseases 2016 67, e5-e7DOI: (10.1053/j.ajkd.2015.12.007) Copyright © 2016 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 Cryoglobulin-related glomerulonephritis with mesangial and segmental, peripheral capillary loop elongated segments of deposits with smooth outer border. This suggests subendothelial location of deposits. There is also staining within capillary loops corresponding to cryoglobulin plugs seen by light microscopy. (immunofluorescence microscopy, immunoglobulin M). American Journal of Kidney Diseases 2016 67, e5-e7DOI: (10.1053/j.ajkd.2015.12.007) Copyright © 2016 National Kidney Foundation, Inc. Terms and Conditions

Figure 4 Cryoglobulin-related glomerulonephritis with strong discontinuous capillary wall and mesangial segmental deposits. Complement typically co-localizes with immunoglobulins (immunofluorescence microscopy, C3). Reproduced with permission from AJKD 33(1):e1. American Journal of Kidney Diseases 2016 67, e5-e7DOI: (10.1053/j.ajkd.2015.12.007) Copyright © 2016 National Kidney Foundation, Inc. Terms and Conditions

Figure 5 Cryoglobulin-related glomerulonephritis with subendothelial deposits (arrows) and cryoglobulin plugs (asterisks; electron microscopy). American Journal of Kidney Diseases 2016 67, e5-e7DOI: (10.1053/j.ajkd.2015.12.007) Copyright © 2016 National Kidney Foundation, Inc. Terms and Conditions

Figure 6 Cryoglobulin-related glomerulonephritis with wormy, short fibrillary substructure of subendothelial deposits. This type of substructure suggests a cryoglobulin causing the deposits (electron microscopy). American Journal of Kidney Diseases 2016 67, e5-e7DOI: (10.1053/j.ajkd.2015.12.007) Copyright © 2016 National Kidney Foundation, Inc. Terms and Conditions