Lupus nephritis with podocytic infolding and intramembranous microstructures

We describe a 24-year-old woman with a distinctive glomerular lesion. She presented with nephrotic syndrome and the diagnosis of systemic lupus erythematosus was made on the basis of laboratory and clinical findings. Renal biopsy showed a bubbling appearance of the glomerular capillary wall indicating lupus nephritis class V. On an electron microscopy, the glomerular basement membrane (GBM) was irregularly thickened and contained abundant vesicular and microtubular bodies. In addition, there were many epithelial foot processes infolding into the GBM. A few small deposits were observed beneath the foot processes and around the vesicular and microtubular bodies. Although the clinicopathological significance of podocytic infolding has not been fully elucidated, it may be a novel morphological entity in the glomerulonephritides.