Review Question - QID 100986

The patient's presentation and EM are consistent with post-streptococcal (postinfectious) glomerulonephritis. The white arrows demonstrate epimembranous immune complex deposits of IgG, IgM and C3.

In post-streptococcal glomerulonephritis (PSGN), the immune complex deposits consist of IgG, IgM, and C3. This condition is usually self-limited and requires only supportive treatment. Because PSGN is immune complex driven (not streptococcus), it does not improve with antibiotics. Younger patients with PSGN have a better prognosis than older patients.

According to Hahn et al., PSGN is most frequently encountered in children ages two to six years of age with a recent history of pharyngitis and a rash in the winter months. Post-streptococcal illnesses in children include acute rheumatic fever, pediatric autoimmune neuropsychiatric disorders, and post-streptococcal glomerulonephritis.

As reviewed by Eison et al., PSGN is an important cause of acute renal failure in children in both the developed and developing worlds, and has an overall good prognosis.

Figure A shows the classic epimembranous immune complex deposition on EM.

Incorrect Answers:
Answer 1: Albumin is not the structure seen in this EM.
Answer 2: Non-enzymatic glycosylation would not be visible on EM.
Answer 3: While IgA nephropathy has granular EM deposits, they are located in the mesangium and not in the sub-epithelium.
Answer 4: The deposits identified contain IgM and C3 in addition to IgG