Created at 4:35 a.m. Apr, 04, 2026
Author: mari1
Related Note: 1475364023607 3
Rationale for change

Membranous nephropathy spike and dome appearance is more often seen with silver staining (currently card says electron microscopy)

UWorld Question ID 15346 answer explanation: Electron microscopy (EM) of the glomerular capillary demonstrates irregular, electron-dense immune deposits located on the glomerular basement membrane (GBM) with moderate effacement of the podocyte foot processes, consistent with membranous nephropathy (MN). MN results from immune-complex deposition in the subepithelial portions of the GBM. Light microscopy demonstrates diffuse glomerular capillary wall thickening without hypercellularity, whereas silver staining reveals "spikes and domes" of GBM that protrude between the immune deposits (which do not stain).
Source: UWorld - Step 1 15346

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