1. Normal H&E Distal tubule Capillary loop Capillary loops are patent
Mesangial cell (not more than 3 adjacent to each other…if >3: mesangial hypercellularity)
Proximal convoluted tubule (foamy cytoplasm)
This may be an endothelial or a mesangial cell (no problem)

2. Normal
PAS
Positive = fuchsia color as the color of basement membranes here
This is the normal thicknes of GBM as highlighted by PAS…try to train your eyes on this thickness
As you see: the BM surrounding every thing is well-highlighted by PAS
Visceral epithelial cells

3. GBM Blood Normal EM Podocyte (visceral epithelial cell) foot process
Slit diaphragm
…the area is called: filtration slit
Blood
A fenestration in endothelial cell

4. RBC When we see this change alone without LM or IF change:
Minimal change
disease
Effaced foot process
GBM
RBC

5. Example of FSGS
…H&E
Eosinophilic material (fibrosis) that effaced the capillary loops…as you see just the change is in a segment of glomerulus…= segmental sclerosis
Hyaline mass…may accompany FSGS…may resemble fibrin

6. Example of FSGS
…Masson trichrome stain
…collagen is blue
The fibrosis appears bluish in color
…again this is segmental sclerosis

7. A case of poststreptococcal
GN…H&E
Lobulation
neutrophils
Enlargement & lobulation of the glomerulus + proliferation of all cells in the area + inflammatory cells…this proliferation causes capillary loops to be closed…this appearance can be seen in postinfectious glomerulonephritis and in MPGN1/DDD…the presence of neutrophils may be a hint for poststrept. GN

8. Higher power of image in slide 7

9. Formed of IgG & C3
Poststreptococcal glomerulonephritis
Subepithelial hump (between the GBM and the podocyte)
Foot process
(Capillary lumen)

10. IF: A case of membranous nephropathy: granular capillary pattern

11. H&E
A case of membranous nephropathy…in this example, the abnormality seen is just GBM thickening
Thickened GBM

12. Membranous nephropathy (silver stain)
Silver stains BM black
Spikes (processes of GBM that are formed as a reaction to subepithelial deposits)…best seen by silver, but may also by PAS or even H&E by expert eyes)

13. Membranous nephropathy

14. IF: A case of membranous nephropathy: granular capillary pattern

15. IF: A case of membranous nephropathy: granular capillary pattern

16. Crescentic GN (a change that can be seen in many diseases especially those that cause rapidly progressive GN)
…this is
PAS stain
Proliferation of parietal cells + macrophages as a crescent
In this case it is early crescent (cellular crescent)

17. H&E
Crescent…in this example it is somewhat late crescent (started to become fibrosed…fibrous crescent)

18. IF: linear capillary pattern (anti-GBM antibody/Goodpasture syndrome)

19. H&E
Mesangial hypercellularity (more than 3 adjacent mesangial cells)
A nonspecific change but remember it very well in IgA nephropathy

20. IF: granular mesangial pattern

21. IF: granular mesangial pattern

22. H&E:
A case of membranoproliferative
Glomerulonephritis 1 or DDD (dense
deposit disease)
Enlargement + proliferation of all cells in the area + inflammatory cells…this proliferation causes capillary loops to be closed…this appearance can be seen in postinfectious glomerulonephritis and in MPGN1/DDD…the presence of neutrophils may be a hint for poststrept. GN
…no neutrophils here (but still this can be seen
In poststrep.)

23. MPGN1 or DDD…silver stain
Tram track appearance (2 lines draw the GBM)…best seen by silver (as in this case)
MPGN1 or DDD…silver stain

24. Thank You