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 Table of Contents  
TEACHING POINT
Year : 2018  |  Volume : 18  |  Issue : 1  |  Page : 43-44

Teaching point: Renal histopathology in a patient with nephrotic syndrome


1 Department of Morbid Anatomy and Forensic Medicine, OAUTHC, Ile-Ife, Nigeria
2 Department of Medicine, Nephrology Unit, OAUTHC, Ile-Ife, Nigeria

Date of Submission10-Jun-2020
Date of Acceptance10-Jun-2020
Date of Web Publication27-Feb-2021

Correspondence Address:
Dr. A A Abiola
Department of Morbid Anatomy and Forensic Medicine, OAUTHC, Ile - Ife
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njhs.njhs_23_20

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How to cite this article:
Abiola A A, Adelusola K A, Arogundade F A. Teaching point: Renal histopathology in a patient with nephrotic syndrome. Niger J Health Sci 2018;18:43-4

How to cite this URL:
Abiola A A, Adelusola K A, Arogundade F A. Teaching point: Renal histopathology in a patient with nephrotic syndrome. Niger J Health Sci [serial online] 2018 [cited 2021 Apr 20];18:43-4. Available from: https://www.chs-journal.com/text.asp?2018/18/1/43/310338




  Clinical Information Top


The patient is a 32-year-old man who presented with a 3-year history of recurrent generalised body swelling, frothiness of urine, hypercholesteroleamia and hypoalbumineamia.

He subsequently had a renal biopsy done on account of nephrotic syndrome. The renal tissue obtained was processed for light microscopy using heamatoxylin and eosin, Jones methenamine, periodic acid–Schiff (PAS) stains as well as immunoperoxidase stains (immunoglobulin [Ig] G, IgM, IgA and C3) [Figure 1], [Figure 2], [Figure 3], [Figure 4].
Figure 1:

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Figure 2:

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Figure 3:

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Figure 4:

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  Questions Top


1 Describe the features shown in the histology slides 1-4

2 What is the histological diagnosis?

The H and E stain and PAS stain show glomeruli with diffuse thickening of glomerular basement membrane with no hypercellularity or double contour formation [Figure 1]. There are spikes on the capillary basement membrane seen on JMS stain [Figure 2].

The immunoperoxidase staining shows granular IgG and C3 staining pattern along the capillary basement membrane due to subepithelial immune complex deposits in the glomeruli [Figure 3] and [Figure 4].

All the above histological features are consistent with membranous glomerulonephritis.

Membranous glomerulonephritis is a type of glomerular disease that manifests clinically as nephrotic syndrome. It is one of the most common histomorphological patterns seen amongst adult individuals presenting with nephrotic syndrome. It is much rarer as a cause of nephrotic syndrome in children in which case it is most often secondary to infections, for example, HBV infection.

Pathogenetically, it is most often a renal limited autoimmune disease characterised by the production of autoantibody against phospholipase-A2 receptor – an endogenous antigen – on the glomerulus and this is referred to as primary membranous glomerulonephritis. It could also be secondary to some systemic conditions as well as infections, for example, HBV, systemic lupus erythematosus, lung carcinoma, colon cancer, prostate cancer and drugs.

The resultant immune complex formed is deposited on the subepithelial space of the glomerulus leading to activation of complement which subsequently causes damage to the foot processes of the podocyte with resultant proteinuria.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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