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Subepithelial deposits with microspherular structures in membranous glomerulonephritis.

Hae Yoon Grace Choung1, Jerome Jean-Gilles1, Bruce Goldman1

  • 1Department of Pathology and Laboratory Medicine, Division of Renal Pathology and Electron Microscopy, University of Rochester Medical Center, Rochester, NY, USA.

Ultrastructural Pathology
|June 16, 2022
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Membranous glomerulopathy (MGN) with subepithelial microspherular structures often indicates an underlying autoimmune disease, particularly lupus. Many cases lack primary MGN markers, suggesting secondary causes.

Keywords:
Membranous nephropathyautoimmune disordermembranous glomerulopathy with spherulesmicrospherulespodocyte infolding glomerulopathy (PIG)spherulessystemic lupus erythematosus

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Area of Science:

  • Nephrology
  • Pathology
  • Immunology

Background:

  • Membranous glomerulopathy (MGN) can present with unique subepithelial microspherular structures.
  • These structures have been termed MGN with spherules or podocyte infolding glomerulopathy (PIG).
  • Previous studies suggest a link to autoimmune conditions, but further investigation is needed.

Purpose of the Study:

  • To investigate the clinical significance and underlying causes of MGN with subepithelial microspherular structures.
  • To determine the association with autoimmune diseases and common primary MGN markers.

Main Methods:

  • Retrospective analysis of 10 native kidney biopsies with identified subepithelial microspherular structures.
  • Review of patient demographics, clinical history, and autoimmune markers.
  • Immunohistochemical staining for PLA2R, NELL1, and THSD7A.

Main Results:

  • The majority of patients were Caucasian (80%) with a mean age of 51.3 years.
  • 50% of cases were associated with autoimmune disorders, predominantly Systemic Lupus Erythematosus (SLE) (80% of autoimmune cases).
  • 40% of cases were idiopathic and negative for PLA2R, NELL1, and THSD7A, suggesting secondary MGN.

Conclusions:

  • MGN with subepithelial microspherular structures is frequently associated with underlying autoimmune diseases.
  • The frequent absence of primary MGN markers supports a diagnosis of secondary MGN in these cases.