Immunotactoid Glomerulopathy

Another disorder with peculiar ultrastructural features is known as immunotactoid glomerulopathy (Fig. 19.2) (1,4,10). The light microscopic appearance of glomeruli is typically of a membranoproliferative

Figure 19.1. Fibrillary glomerulonephritis; there are numerous randomly arranged fine fibrils permeating the basement membrane (electron microscopy).

glomerulonephritis type I pattern. Immunofluorescence microscopy discloses granular capillary wall deposits of IgG, complement, and one or both light chains. In this entity, glomerular immune (electron-dense) deposits are composed of numerous coarse hollow-cored fibrils (immuno-tactoids) ranging in thickness from approximately 20 to 80 nm. Patients present with heavy proteinuria and hematuria; approximately 50% have been found to have a concurrent or subsequently developing lymphopro-liferative disease (1,11).

Table 19.1. Features of amyloid and fibrillary glomerulonephritis (GN)

Amyloid Fibrils 10-12 nm

Extraglomerular renal involvement—vessels, interstitium, etc. Extrarenal involvement common Congo red positive

Fibrillary GN Fibrils 10-20 nm

Rare extraglomerular renal involvement

Extrarenal involvement rare Congo red negative

Figure 19.2. Immunotactoid glomerulopathy; the large subendothelial deposit is composed of many hollow-cored tubular structures, some of which are in cross section (electron microscopy).
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