Membranous GN

Question 1

histopathological findings

Answer 1

Ig and complement deposit in **subepithelial **

Question 2

Autoantibodies related to primary MN

Answer 2

1. PLA2R (80%)
2. THSD7A (1-2%)
3. SEMAphorin 3b
4. NELL-1
5. Exostosin 1&2

*primary MN: 70%

Question 3

Causes of secondary MN?

Answer 3

1. Autoimmune / SLE
2. viral: Hep B > Hep C / Syphilis
3. Malignancy - solid organ
4. drugs: penicillamine, NSAIDS

30% sec MN

Question 4

Autoantibosies related to malignancy?

Answer 4

1. NELL-1
2. THSD7A

Question 5

What is alloimmune MN?

Answer 5

1. GVHD
2. denovo MN in kidney allograft
3. Antenatal alloimmune MN caused by anti-NEP ab

Question 6

risk of kidney failure with MN?

Answer 6

1. conservative rx: 35-**40% **
2. +IS: 8-11%

Question 7

risk of relapse MN?
(after complete remission)

Answer 7

25-30%

higher after PR

Question 8

histopathological finding in MN

Answer 8

subepithelial deposit + (intramembranous)

LM:
1. thickened GBM
2. spikes and crater
3. chronic changes: GS/ IFTA

IF
1. granular
2. IgG
3. C3
4. PLAR Ab stain

crater - in early course of disease / area of translucency

Question 9

histological features of secondary MN

Answer 9

1. IF: full house (SLE class v)
2. IgG 1-3
3. EM: subendothelial deposit/ mesangial deposit / tubuloreticular structure