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NBME 21 Answers

nbme21/Block 3/Question#34

A 39-year-old woman with rheumatoid arthritis ...

Membranous glomerulonephritis

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 +3  upvote downvote
submitted by mcl(167),

Membranous glomerulopephritis (aka membranous nephropathy, p 584 FA 2019) may occur secondary to drugs such as penicillamine. Immunofluorescence shows granular deposits due to immune complex deposition. Will also see diffuse capillary and GBM thickening, and SEM will show spike and dome appearance due to subepithelial deposits.


 +3  upvote downvote
submitted by deannosancuck(3),

Membranous Glomerulonephritis is Nephrotic; ONLY PROTEINURIA is in the vignette

It can't be MPGN because MPGN is Nephritic with possible Nephrotic

Other choices are eliminated by Renal Biopsy

hungrybox  agreed "granular deposits" rules out MCD (the only other nephrotic syndrome) because MCD is IF (-) +2  

 +0  upvote downvote
submitted by sahusema(12),

It sounds a lot like PSGN, but PSGN is nephritic and we would see pronounced hematuria with minimal proteinuria.