A 35-year-old man with hepatitis B infection develops nephrotic syndrome. Biopsy shows subepithelial 'spike and dome' deposits on silver stain and granular IgG on immunofluorescence. What is the most likely diagnosis?

• A IgA nephropathy
• B Membranoproliferative glomerulonephritis
• C Focal segmental glomerulosclerosis
• D Membranous nephropathy ✓

Explanation

Membranous nephropathy is characterized by subepithelial immune complex deposits forming a 'spike and dome' pattern on silver stain (spikes = basement membrane projections between deposits) and granular IgG/C3 on immunofluorescence. Secondary causes include hepatitis B (HBe antigen trapped subepithelially), SLE, and malignancies. Primary membranous nephropathy involves anti-PLA2R antibodies.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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