A 35-year-old female recovering from hepatitis B develops hematuria, proteinuria, and red cell casts in the urine. Which of the following would best describe the changes within the kidney in this patient?
Correct Answer: Granular deposits of antibodies in the glomerular basement membrane
Description: Glomerular injury caused by circulating antigen-antibody complexes is a secondary effect from a nonrenal primary source. Numerous clinical examples exist of a serum sickness-like nephritis as a consequence of systemic infection, with classic clinical models such as syphilis, hepatitis B, malaria, and bacterial endocarditis leading to renal disease. Immune complexes to antigens from any of these sources are circulating within the vascular system and become entrapped within the filtration system of the glomerular basement membranes. This can be seen as granular, bumpy deposits by immunofluorescence within the basement membranes of the glomeruli. Linear fluorescence, on the other hand, is seen in primary antiglomerular basement membrane disease, in which antibodies are directed against the glomerular basement membrane itself. Plasma cell interstitial nephritis is seen in immunologic rejection of transplanted kidneys. Nodular glomerulosclerosis is an effect of diabetes mellitus. The presence of red blood cell casts in the urine nearly always indicates that there has been glomerular injury but is not specific for any given cause. Thickening of the glomerular basement membrane caused by subepithelial immune deposits is seen in membranous glomerulonephritis. While the morphology of membranous glomerulonephritis is different from that of nephritis caused by circulating antigen-antibody complexes (immune complexes), there are similarities in the pathogenesis in that both disorders may be a consequence of or exist in association with infections such as hepatitis B, syphilis, or malaria. Other causes of membranous glomerulonephritis include reactions to penicillamine and gold, and ceain malignancies such as malignant melanoma. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition
Category:
Pathology
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