Fogo, Ch. 3 - Membranoproliferative Glomerulonephritis

Question 1

Distinguish between the three types of membranoproliferative glomeronephritis.

Answer 1

I: Typical. Combined nephritic & nephrotic clinical picture with reduced complement.

II: Dense deposit disease, related to C3 nephropathy.

III: Rare, without C3 nephritic factor.

Question 2

What are the glomerular features of membranoproliferative glomerulonephritis?

Answer 2

Subendothelial deposits with GBM double-contour. Can have inflammatory cells, crescents.

Question 3

Distinguish between the LM findings in primary vs secondary membranoproliferative glomerulonephritis.

Answer 3

Glomerular disease is more uniform and diffuse in primary than in secondary.

Question 4

What are the late-stage LM findings in membranoproliferative glomerulonephritis?

Answer 4

Sclerosis, tubular atrophy, interstitial fibrosis and vascular sclerosis.

Question 5

What are some unique LM features to type II and III membranoproliferative glomerulonephritis?

Answer 5

II: Can also have subepithelial deposits.

III: BM is thickened and eosinophilic.

Question 6

What are the IF findings in MPGN?

Answer 6

Variable; usually irregular capillary and mesangial IgG/M/C3.

Question 7

What are the EM findings in MPGN?

Answer 7

Subendothelial and mesangial deposits with new basement membrane and variable podocyte changes. Sometimes wormy/microtubular inclusions.

Question 8

What diseases are associated with MPGN? How may they appear different?

Answer 8

HBV/HCV, syphilis, infectious endocarditis.

HCV may have cryoglobulins and fibrillar deposits.

Question 9

What abnormalities are associated with dense deposit disease?

Answer 9

Autoantibodies to C3 convertase, maybe factor H abnormalities.

Question 10

What is the prognosis/outlook for MPGN?

Answer 10

Poor; inexorable downhill course. Treatment is directed at underlying causes but disease often recurs even in transplanted tissue.