What is your diagnosis in a patient with nephrotic syndrome?
The electron photomicrograph demonstrates frequent subepithelial deposits along the glomerular basement membrane characteristic of Membranous GN. Subsequent staining with an immunoperoxidase stain for Phospholipase A2 receptor 1 (PLA2R) was strongly and diffusely positive in this case consistent with a primary Membranous GN. By light microscopy, the classic findings include thickened glomerular basement membranes, pinholes (or bubbles), and spikes along the capillary loops with the Jones silver stain. However, it should be noted that the degree, or severity, of these findings can be extremely variable from case to case.
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