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Key diagnostic features of selected diseases in renal biopsy are illustrated, with light, immunofluorescence, and electron microscopic images. Common urinalysis findings are also documented.

Figure e14-1

Minimal-change disease. In minimal-change disease, light microscopy is unremarkable (A), while electron microscopy (B) reveals podocyte injury evidenced by complete foot process effacement. (ABF/Vanderbilt Collection.)

Figure e14-2

Focal segmental glomerulosclerosis (FSGS). There is a well-defined segmental increase in matrix and obliteration of capillary loops, the sine qua non of segmental sclerosis not otherwise specified (nos) type. (EGN/UPenn Collection.)

Figure e14-3

Collapsing glomerulopathy. There is segmental collapse of the glomerular capillary loops and overlying podocyte hyperplasia. This lesion may be idiopathic or associated with HIV infection and has a particularly poor prognosis. (ABF/Vanderbilt Collection.)

Figure e14-4

Hilar variant of FSGS. There is segmental sclerosis of the glomerular tuft at the vascular pole with associated hyalinosis, also present in the afferent arteriole (arrows). This lesion often occurs as a secondary response when nephron mass is lost due to, e.g., scarring from other conditions. Patients usually have less proteinuria and less steroid response than FSGS, nos type. (ABF/Vanderbilt Collection.)

Figure e14-5

Tip lesion variant of FSGS. There is segmental sclerosis of the glomerular capillary loops at the proximal tubular outlet (arrow). This lesion has a better prognosis than other types of FSGS. (ABF/Vanderbilt Collection.)

Figure e14-6

Postinfectious (poststreptococcal) glomerulonephritis. The glomerular tuft shows proliferative changes with numerous PMNs, with a crescentic reaction in severe cases (A). These deposits localize in the mesangium and along the capillary wall in a subepithelial pattern and stain dominantly for C3 and to a lesser extent for IgG (B). Subepithelial hump-shaped deposits are seen by electron microscopy (C). (ABF/Vanderbilt Collection.)

Figure e14-7

Membranous glomerulopathy. Membranous glomerulopathy is due to subepithelial deposits, with resulting basement membrane reaction, resulting in the appearance of spike-like projections on silver stain (A). The deposits are directly visualized by ...

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