TOPIC DISCUSSION; Stages of Membranous GN

On Electron microscopy, Membranous is defined by electron dense deposits in the sub epithelial region.

Classically there are 4 stages:
Stage 1:- sparse deposits, LM can even look normal.
Stage 2:- most commonly noted finding, the classic Spikes appearance
Stage 3:- deposits with overlying membrane formation, looks like a chain like formation
Stage 4:- disappearance of the deposits.

Interestingly, these stages don't correlate clinically
Progression from one to another could even mean improvement or worsening of proteinuria
We usually encounter Stage 2 most of the times
But just in one glomerulus, you can find multiple stages!

Ref: Neph Sap July 2011