Case 7: Additional Pathology

Case 7 Index

Finally, some additional preparations are ready! Take a look below…

EM (Electron Microscopy)

Which of the following do you see above (more than one may be correct)?
Tubuloreticular inclusion (TRI)
Well  done! TRIs are seen within the endothelial cell and are thought to arise from the endoplasmic reticulum.
Subepithelial deposits
We don’t see any significant subepithelial deposits here, try again!
Subendothelial deposits
Correct! Here we see deposits along the basement membrane on the side of the capillary lumen, therefore in the subendothelial space!
Duplication or “tram-tracking” of the basement membrane
The basement membrane appears to be intact here, with only one layer visible. Try again!
Mesangial deposits
Though there are mesangial changes and there may be mesangial deposits, the mesangium is not visualized above.

IF (Immunofluorescence)

IgG

Glomerular and TBM IgG Deposits

C1q

Glomerular C1q Deposition

IgM

Granular, Glomerular IgG Deposits

C3

Glomerular C1q Deposition

What do you see above on immunofluorescence (IF) for this patient?
Granular basement membrane staining
Correct! This is consistent with immune deposition disease and our many subendothelial deposits that we saw on EM. We also see staining of the mesangial space.
Linear basement membrane staining
We do not see a linear pattern here, which would be inconsistent with the subendothelial deposits and unaffected basement membrane as seen on EM in this patient. Try again!
Negative IF staining
Negative IF would appear as a dark shadow. In addition, we see subendothelial deposits on EM above, implying the presence of immune deposits. Negative IF would suggest the absence of immune deposits.
It’s time to lock in your final diagnosis! Choose 1 before finishing the case.
Membranous nephropathy
Post-infectious glomerulonephritis
Acute interstitial nephritis (AIN)
ANCA-associated glomerulonephritis
Systemic lupus erythematosus (SLE) nephritis
Minimal change disease
Acute tubular necrosis (ATN)
IgA nephropathy
Hepatitis C-related glomerulonephritis
Anti-glomerular basement membrane (GBM) disease

Click here if you’re confident in your final diagnosis!

Case 7 Index
Case 7 Introduction
Case 7 Physical Exam
Case 7 Diagnostic Testing
Case 7 Pathology