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Difficulty: MediumPathology and Biopsy Interpretation

Match the following renal biopsy findings (including light microscopy, immunofluorescence, and electron microscopy features) to their corresponding primary glomerular disease.

  • Subepithelial immune complex deposits showing a 'spike and dome' appearance on silver stainMembranous nephropathy
  • Normal light microscopy with diffuse podocyte foot process effacement on electron microscopyMinimal change disease
  • Mesangial hypercellularity with prominent IgA codeposits on immunofluorescenceIgA nephropathy
  • Subepithelial electron-dense 'humps' with granular IgG and C3 depositionPoststreptococcal glomerulonephritis
  • Patchy involvement showing capillary loop collapse, segmental scarring, and hyalinosisFocal segmental glomerulosclerosis

Answer

Subepithelial 'spike and dome' matches Membranous nephropathy. Normal light microscopy with podocyte effacement matches Minimal change disease. Mesangial IgA deposits match IgA nephropathy. Subepithelial 'humps' match Poststreptococcal glomerulonephritis. Patchy segmental scarring matches Focal segmental glomerulosclerosis.
Each renal pathology finding is a hallmark classic pattern for the corresponding glomerular disease, essential for establishing a definitive diagnosis based on biopsy interpretation.

Step-by-Step Solution

1
Analyze the description: 'spike and dome' appearance.
Identify as Membranous nephropathy.
This is a pathognomonic description of the basement membrane reacting to subepithelial immune deposits in membranous nephropathy.
2
Analyze the description: normal light microscopy with podocyte effacement.
Identify as Minimal change disease.
The defining feature of this disease is the lack of light microscopic findings combined with isolated structural podocyte injury.
3
Analyze the description: mesangial hypercellularity with IgA.
Identify as IgA nephropathy.
The presence of IgA in the mesangium is the hallmark diagnostic finding for Berger disease.
4
Analyze the description: subepithelial 'humps' and IgG/C3.
Identify as Poststreptococcal glomerulonephritis.
Acute postinfectious glomerulonephritis forms large subepithelial immune complexes that appear as humps on electron microscopy.
5
Analyze the description: patchy capillary loop collapse and segmental scarring.
Identify as Focal segmental glomerulosclerosis.
The description defines a process that is focal (patchy) and segmental (part of the tuft), characterizing FSGS.

Key Concept

Identifying definitive biopsy features (light, immunofluorescence, and electron microscopy) of primary glomerular diseases is essential for establishing an accurate nephrologic diagnosis.
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Topics

Pathology and Biopsy Interpretation

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