Renal biopsy from a 19-year-old woman with low serum complement and nephrotic-range proteinuria shows lobular glomeruli with splitting of the basement membrane on light microscopy. Electron microscopy reveals continuous ribbon-like extremely electron-dense material replacing the lamina densa. What is the diagnosis?
- A Membranoproliferative glomerulonephritis due to hepatitis C with cryoglobulins
- B Light-chain deposition disease
- C Dense deposit disease ✓
- D Lupus nephritis class IV
Correct answer: C. Dense deposit disease
Explanation
Ribbon-like intramembranous dense deposits replacing the lamina densa are diagnostic of dense deposit disease, formerly called MPGN type II, a disorder of alternative complement pathway dysregulation associated with B3 nephritic factor. Hepatitis B related MPGN and lupus show discrete subendothelial and mesangial deposits rather than transformation of the lamina densa itself.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.