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An excerpt from the Great Big Book -
CLINICAL: MOST COMMON cause of nephrotic syndrome in adults (25-40% of nephrotic syndrome patients have Membranous Glomerulopathy. The most common cause of nephrotic syndrome in children is minimal change disease.) Membranous glomerulopathy (MG) is more common in MALES. The disease is SLOWLY PROGRESSIVE (40% renal failure, 10 year survival 80-90%, poor prognosis if high BP, segmental glomerular sclerosis, interstitial fibroisis, heavy proteinuria). RENAL VEIN THROMBOSIS is a typical complication (although not common). There is a low recurrence rate in transplants. MG is the most common De Novo disease in transplants.
ETIOLOGY: IDIOPATHIC (in situ immune complex formation) vs SECONDARY (SLE, HBV, Syphilis, neoplasms if older than 60, gold, mercury, D-penicillamine, NSAIDs, RA, thyroiditis, IBD).
PATHOLOGIC FINDINGS - H&E: thickened basement membranes. EM: SUBEPITHELIAL dense deposits. PAS-SILVER STAIN: Thickening of GBM, PAS positive spikes around deposits, moth eaten GBM, glomeruli are NOT hypercellular. IMMUNOFLOURESCENCE: Typically, MG has diffuse (all glomeruli) global (entire glomerulus) granular staining of the capillary walls. Rare specimens will have segmental staining. The composition of immune deposits is almost always IgG-dominant. C3 staining is usually very low intensity in idiopathic(primary) membranous glomerulopathy, which is very different from a post-infectious glomerulonephritis in which there is usually intense C3 staining along with very low intensity or absent IgG staining.
----Comment by: PathDoc15 on 11/7/2008 6:51:38 AM
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