Membranous glomerulonephritis with unusual C3 deposits: case series report

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https://storage.unitedwebnetwork.com/files/1099/d1244b5e930650dbb59247d239e770bc.pdf

Abstract Title

First Name *

Laura

Last Name *

Biederman

Co-author 1

Anjali Satoskar anjali.satoskar@osumc.edu the OSU pathology Columbus

Co-author 2

Alana Dasgupta alana.dasgupta@osumc.edu the OSU pathology Columbus

Co-author 3

Charles Nicely Charles.Nicely@ohiohealth.com the NCH pathology Columbus

Co-author 4

Madeline Chung madeline.chung@osumc.edu the OSU Medicine Columbus

Co-author 5

Sergey Brodsky sergey.brodsky@osumc.edu the OSU pathology Columbus

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Methods

Results

The patients were a 51-year old male, a 79-year old male and a 82-year old female. All 3 cases were present in 2021-2023, and all patients had either COVID-19 infection or vaccination. None of such cases were seen prior to 2021. Light microscopy showed diffuse proliferative and exudative changes in the glomeruli. None of the 3 patient’s had lupus nephritis, and the immunofluorescence did not show "full house" immunoreactivity and were negative for C1q. All biopsies showed positive staining for IgG by immunofluorescence and a clear, membranous pattern of immune complex deposition by electron microscopy. All cases had dominant IgG4 subclass staining, two pf them had a weak positive PLA2R staining and one was PLA2R negative. However, they also showed strong positive staining for C3 by immunofluorescence and distinct large, subepithelial, "hump-like deposits" by electron microscopy, such as are classically associated with infection associated glomerulonephritis or C3 glomerulonephritis.

Conclusions

We present an unusual cases of MN that showed some features of primary MN, but also features resembling C3 glomerulonephritis. None of the patients had underlying autoimmune disease, monoclonal gammopathy or recent infection. All patients either had COVID-19 infection or were vaccinated against it. Thus, COVID-19 infection or vaccination could modulate immune system, resulting in an unusual presentation of MN.

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