Unmasking a unique glomerular lesion

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Unmasking a unique glomerular lesion Christine VanBeek, Mark Haas Kidney International Volume 86, Issue 1, Pages 13-15 (July 2014) DOI: 10.1038/ki.2013.557 Copyright © 2014 International Society of Nephrology Terms and Conditions

Figure 1 Comparison of renal biopsy findings by light microscopy, immunofluorescence for C3, and electron microscopy in two cases of C3 glomerulopathy and one case of primary membranous glomerulopathy. (a, d, g) Light microscopy. (b, e, h) Immunofluorescence for C3. (c, f, i) Electron microscopy. In the case of membranous glomerulopathy (g–i), immunofluorescence for immunoglobulin G (IgG) and immunoperoxidase staining for phospholipase A2 receptor were positive with a pattern similar to that seen for C3 (h). In the two cases of C3 glomerulopathy (C3G) (a–f), there was minimal staining for IgG, IgA, or IgM. The light microscopic findings in all three cases, ranging from mesangial hypercellularity (a) to normocellular glomeruli (d, g), are all within the range of findings described in the cases of Larsen et al.3 (this issue), and all three cases show predominantly glomerular capillary wall staining for C3 by immunofluorescence, with similar, confluent granular staining patterns in one case of C3G (e) and the case of membranous glomerulopathy (h). By electron microscopy, one case of C3G (c) shows intramembranous and transmembranous deposits ranging from moderately electron-dense to largely electron-lucent, in a pattern similar to that described for membranoproliferative glomerulonephritis, type 3 of Strife and Anders.1 The deposits in the other case of C3G (f), while moderately electron-dense, are less well-defined and more segmental than those in the case of membranous glomerulopathy (i), with one deposit in the former case having a somewhat elongated appearance (f, glomerular basement membrane at right). (a, d, g) Periodic acid–Schiff stain; original magnification, × 400. (b, e, h) Immunofluorescence on fresh frozen tissue with fluorescein isothiocyanate-conjugated anti-human C3; original magnification, × 400. (c, f, i) Electron microscopy with uranyl acetate and lead citrate stain; original magnifications, × 7500 (c), × 14,000 (f), × 7200 (i). Kidney International 2014 86, 13-15DOI: (10.1038/ki.2013.557) Copyright © 2014 International Society of Nephrology Terms and Conditions