Abstract
A 69-year-old woman presented with unusual electron microscopic findings. The patient was admitted to ascertain the cause of her persistent proteinuria, and kidney biopsy was performed. While light microscopic findings and immunofluorescence study suggested membranous nephropathy, electron microscopic study showed microspheric particles aggregated in the subepithelial space where electron-dense deposits should have existed. While the microspheric particles could have been unusual and rough deposits, detailed study suggested that the particles could be parts of glomerular podocytes, for example foot processes. This unusual finding was considered as being in a unique clinical course of membranous nephropathy, but a variant of glomerulopathy associated with podocytic infolding, proposed by Joh et al. (J Nephrol 49:61–67, 2007), could not be excluded.
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References
Joh K, Taguchi T, Kobayashi Y, Sato H, Nishi S, Katafuchi R, et al. A preliminary report of national research on podocytic infolding glomerulopathy [article in Japanese]. J Nephrol. 2007;49:61–7.
Ghadially FN. Spherical microparticles. In: Ghadially FN, editor. Ultrastructural pathology of the cell and matrix. 3rd ed. London: Butterworths; 1988. pp. 1080–8.
Burkholder PM, Hyman LR, Barber TA. Extracellular clusters of spherical microparticles in glomeruli in human renal glomerular diseases. Lab Invest. 1973;28:415–25.
MacDonald MK. EM in the classification of glomerulonephritis. In: Kincaid-Smith P, Mathey TH, Becker EL, editors. Glomerulonephritis: morphology, natural history and treatment. New York: Wiley; 1973. p. 111–23.
Inoue M, Nomura S, Ishikawa E, Obe T, Nakano T. A case of membranous nephropathy with unusual microspherical particle (like a Punica granatum). Abstract of the 32nd JSN Western Regional Meeting, 2002 [abstract in Japanese].
Debiec H, Guigonis V, Mougenot B, Decobert F, Haymann JP, Bensman A, et al. Antenatal membranous glomerulonephritis due to anti-neutral endopeptidase antibodies. N Engl J Med. 2002;346:2053–60.
Matsuo S, Brentjens JR, Andres G, Foidart JM, Martin GR, Martinez-Hernandez A. Distribution of basement membrane antigens in glomeruli of mice with autoimmune glomerulonephritis. Am J Pathol. 1986;122:36–49.
Kinoshita Y, Osawa G, Morita T, Kobayashi N, Wada J. Chronic nephritis (Alport) complicated by nephrotic syndrome. Light, fluorescent and electron microscopic studies of renal biopsy specimens. Acta Med Biol. (Niigata). 1969;17:101–17.
Nomura S, Naito I, Fukushima T, Tokura T, Kataoka N, Tanaka I, et al. A splicing mutation in the alpha 5(IV) collagen gene of a family with Alport’s syndrome. Kidney Int. 1993;43:1116–24.
Acknowledgments
The authors acknowledge the support of Gengo Osawa, MD, and Hidekazu Shigematsu, MD, for their valuable discussion, and Satoru Ogawa PhD, Electron Microscopy Research Center Mie University Faculty of Medicine, for his technical support.
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Nomura, S., Inoue-Kiyohara, M., Oosugi, K. et al. Unusual glomerulopathy with aggregated subepithelial microspheric particles resembling membranous nephropathy: a variant of glomerulopathy associated with podocytic infolding?. Clin Exp Nephrol 12, 513–517 (2008). https://doi.org/10.1007/s10157-008-0089-7
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DOI: https://doi.org/10.1007/s10157-008-0089-7