FIGURE 4-4 (see Color Plate)

Hepatitis C virus infection. The most common glomerulonephritis in patients infected with the hepatitis C virus is membra-noproliferative glomerulonephritis with, in some instances, cryoglobulinemia and cryoglobulin precipitates in glomerular capillaries. Thus, the morphology is basically the same as in membranoproliferative glomerulonephritis type I (Fig. 2-18A-C). A, With cryoglobulins, precipitates of protein representing cryo-globulin in the capillary lumina and appearing as hyaline thrombi (HT)are observed (arrows), often with numerous monocytes in most capillaries. B, Immunofluorescence microscopy discloses

peripheral granular to confluent granular capillary wall deposits of immunoglobulin M (IgM) and complement C3; the same immune proteins are in the luminal masses corresponding to hyaline thrombi (arrow). C, Electron microscopy indicates the luminal masses (HT). D, On electron microscopy the deposits also appear to be composed of curvilinear or annular structures (arrows). Hepatitis C viral antigen has been documented in the circulating cryoglobulins. Membranous glomerulonephritis with a mesangial component also has been infrequently described in patients infected with the hepatitis C virus.

FIGURE 4-5 (see Color Plate)

Hepatitis B virus infection. Several glomerulopathies have been described in association with hepatitis B viral infection. Until

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