A 52-year-old man presents with nephrotic syndrome. Serology shows circulating antibodies against phospholipase A2 receptor. Which electron microscopic finding is expected in the glomerular capillary loops?
- A Subepithelial electron-dense deposits with basement membrane spikes ✓
- B Large subendothelial deposits with mesangial interposition
- C Intramembranous ribbon-like dense deposits without immune complexes
- D Diffuse effacement of podocyte foot processes with no deposits
Correct answer: A. Subepithelial electron-dense deposits with basement membrane spikes
Explanation
Primary membranous nephropathy is driven by antibodies to the phospholipase A2 receptor on podocytes, producing subepithelial immune deposits. The basement membrane material deposited between and around these deposits creates spikes on silver stain. Subendothelial deposits with interposition define membranoproliferative GN, while intramembranous dense ribbons define dense deposit disease.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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