Which kidney biopsy findings suggest acute poststreptococcal glomerulonephritis (APSGN)?

Updated: Dec 05, 2018
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Answer

The typical light microscopy findings are that of diffuse hypercellularity of endothelial and mesangial cells and infiltration of the glomerular tuft with polymorphonuclear cells. [57] In more severe cases, epithelial crescents may form during the course of APSGN. In a small percentage of patients, crescentic involvement may be present in over 50% of glomeruli, leading to the clinical picture of rapidly progressive glomerulonephritis. [58, 59, 60]

Immunofluorescence performed on biopsy specimens taken during the acute phase of the illness shows discrete granular deposits of IgG and C3 in a capillary loop and mesangial distribution [61, 62] However, IgG deposits may be absent in about a third of biopsy samples. The presence of heavy and sometimes confluent capillary loop deposits with the total absence of mesangial deposits leads to the starry-sky appearance described in these biopsy reports.

The presence of subepithelial humps on electron microscopy is the hallmark finding in biopsy specimens from patients with APSGN. These electron-dense deposits may also occur in subendothelial and intramembranous locations.


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