Nodular glomerulopathy.

Images in nephrology.

Abstract

Introduction:  Within the differential diagnosis of the injury pattern of nodular glomerulopathy are immunotactoid glomerulopathies, fibrillar glomerulopathies due to fibronectin deposition, diabetic nephropathy and the disease due to monoclonal immunoglobulin deposits.

Clinical case: This is a 36-year-old man with chronic nephrotic syndrome and hypertension who presents deterioration of kidney function, requiring renal replacement therapy in the last 4 months. He has no history of diabetes, and immunological tests were negative. A percutaneous renal biopsy was performed.

Results: Predominantly nodular lesion pattern, with a chronicity index of 9 (nine) with severe chronic changes, global sclerosis in 60% of the glomeruli (3), tubular atrophy in 65 - 70% (3), Interstitial fibrosis in 75-80% (3), intimal sclerosis in 40% of the thickness. Congo’s red stain was negative. IgG immunofluorescence: positive in basement membranes and nodular areas ++/+++. IgA: negative, IgM: negative. Internal control present, C3 positive in basement membranes, and the nodular regions ++/+++, C1q: traces, KAPPA: Positive ++/+++ fine granular in mesangium, LAMBDA: Negative.

Conclusion: Within the differential diagnosis is diabetic glomerulosclerosis, disease due to monoclonal Ig deposits, Amyloidosis, chronic TMA, GN MP type I and III, EDD (GN MO II), Fibrillary glomerulopathy, Glomerulopathy due to immunotactoids, Idiopathic nodular glomerulosclerosis. Electron microscopy is required for definitive diagnosis.