The garland type of acute postinfectious glomerulonephritis: morphological characteristics and follow-up studies

Among 44 patients with acute post-infectious GN, we found 11 cases (10 male, 1 female) displaying an immunohistologically and electron microscopically characteristic "garland pattern". Numerous sub-epithelial deposits of the "hump" type with characteristic patchiness correspond in the electron micrograph to densely packed deposits (IgG, always combined with C3, more rarely also with IgM) demonstrable immunohistologically on the peripheral loops. On the other hand, sub-endothelial, mesangial and intramembranous deposits are less prominent. Clinically, the patients have a strikingly high proteinuria. Follow-up studies have revealed that in a proportion of the patients both the clinical and the morphological findings can regress after a month long course. These are mainly younger patients. On the other hand, in another group of cases (mainly older patients) both the clinical and the morphological findings persist even after months. Within acute post-infectious GN, the "garland type" appears to form a particular group in which a large proteinuria (with or without nephrotic syndrome) and a tendency to chronicity or at least to a protracted course is present in a relatively high percentage.