Fundus changes in (type II) mesangiocapillary glomerulonephritis simulating drusen: a histopathological report.

Abstract

SUMMARY We report for the first time to our knowledge the histopathological findings in the eye of a patient with type II mesangiocapillary glomerulonephritis (dense deposit disease) in which a deposit of material morphologically very similar to that which is pathognomonic for the disease in the kidney was demonstrated in Bruch's membrane. The nature of the deposit in the renal lesion is unknown but is considered to represent a structural alteration secondary to a reaction with anticomplement antibody. Clinically the fundus appearance resembled that seen in drusen.

Differentiating drusen: Drusen and drusen-like appearances associated with ageing, age-related macular degeneration, inherited eye disease and other pathological processes

“…Many of the references below relate to historical descriptions reporting retinal phenotypes observed in patients with renal disease and so we refer to the nephropathy as the authors have. In 1989, Duvall-Young and colleagues working in the Renal Unit at Manchester Royal Infirmary described the presence of drusen-like retinal deposits in patients with biopsy proven MPGN2 (Duvall-Young et al, 1989). Subsequently Mullins and associates, were able to examine eyes obtained from two human donors with MPGN2 .…”

“…Their distribution is variable and as in AMD in the early stages, is not associated with ocular morbidity (Colville et al, 2003;Duvall-Young et al, 1989). With time retinal dysfunction may develop, detectable even when the patient is asymptomatic (Colville et al, 2003;D'Souza Y et al, 2009;O'Brien et al, 1993).…”

Optical coherence tomography of fundus findings in type II mesangiocapillary glomerulonephritis

“…2 Similar deposits have been reported to be present throughout the inner collagenous layer of the Bruch's membrane, and in some areas these may show appearance of focal drusen-like nodules. OCT in the present case demonstrated diffuse involvement of RPE-choriocapillary complex, multiple area of RPE irregularities, and excrescences with high reflectivity deposits underneath, probably representing the electron dense deposits.…”

“…Ocular involvement in type II MCGN has been described in past reports. [1][2][3][4][5] Previous studies suggest that there is great anatomic similarity between the glomerulus and the choriocapillaris; the basement membrane and the Bruch's membrane; the epithelium and the RPE.…”

“…[1][2][3][4] It is characterized by the presence of electron dense deposits in the choriocapillaris and the Bruch's membrane.…”