streptococcus. Typically, patients with glomerulonephritis exhibit hematuria, edema, proteinuria, and hypertension. Renal function frequently is depressed, sometimes severely. Most patients recover spontaneously, and a few go on to rapidly progressive or chronic indolent disease. A, On light microscopy the glomeruli are enlarged and hypercellular, with numerous leukocytes in the capillary lumina and a variable increase in mesangial cellularity. The leukocytes are neutrophils and monocytes. The capillary walls are single-contoured, and crescents may be present. B, On immunofluorescence, granular capillary wall and mesangial deposits of immunoglobulin G and complement C3 are observed (starry-sky pattern). Three predominant patterns occur depending on the location of the deposits; these include garlandlike, mesangial, and starry-sky patterns. C, The ultrastructural findings are those of electron-dense deposits, characteristically but not solely in the subepithelial aspects of the capillary walls, in the form of large gumdrop or hump-shaped deposits (arrow). However, electron-dense deposits also are found in the mesangial regions and occasionally subendothelial locations. Endothelial cells often are swollen, and leukocytes are not only found in the capillary lumina but occasionally in direct contact with basement membranes in capillary walls with deposits. Similar findings may be observed in glomerulonephritis after infectious diseases other than certain strains of Streptococci.

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