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.
We don’t see any significant subepithelial deposits here, try again!
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!
Though there are mesangial changes and there may be mesangial deposits, the mesangium is not visualized above.
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.
Acute interstitial nephritis (AIN)
Systemic lupus erythematosus (SLE) nephritis
Minimal change disease
Acute tubular necrosis (ATN)
Hepatitis C-related glomerulonephritis
Anti-glomerular basement membrane (GBM) disease
Click here if you’re confident in your final diagnosis!