Walker et al reported the histologic features of Dense Deposit Disease, and they presented reasons why this is distinct from membranoproliferative glomerulonephritis. The authors are from Little Rock, Arkansas, San Carlo Borromeo Hospital in Milan, Chiba-East National Hospital in Japan, and Indiana University.
Key histologic features of dense deposit disease:
(1) electron dense deposits in the glomerular basement membrane on electron microscopy
(2) presence of complement C3 on immunofluorescence
Additional findings:
(1) presence of electron dense deposits along the tubular basement membranes
(2) presence of electron dense deposits along the basement membrane of Bowman's capsule
(3) occurrence of crescentic and acute proliferative and exudative patterns in pediatric-aged patients; membranoproliferative and mesangial proliferation patterns can occur at any age
Histologic Features
Pattern
Number
endocapillary proliferation AND thickened capillary loops
membranoproliferative
1
mesangial hypercellularity, focal and segmental
mesangial proliferative
2
crescents in > 50% of glomeruli
crescentic
3
endocapillary proliferation AND neutrophilic infiltration
acute proliferative and exudative
4
none of the above
unclassified
5
Some patients have immunoglobulin deposits on immunofluorescence (usually IgM) but the presence of multiple types (IgM and IgG, IgG and IgA, etc) is not common. The presence of immunoglobulin usually correlates with the mesangial proliferation pattern.
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