Widespread splitting or
lamellation of the GBM is not present, although very localized splitting or
lamellation (Figure 3, C) does not rule out TBMN.
In contrast, in diabetic nephropathy the lamina densa of the glomerular basement membranes is classically thickened, and subepithelial
lamellation is often also present.
A benign outcome is reported in the majority of patients, but glomerular obsolescence, proteinuria, and hypertension may occur.[5,6] The predominant ultrastructural anomaly in the kidney is a diffusely thin glomerular basement membrane (GBM).[2] In contrast to Alport syndrome (AS), there are no widespread areas of thickening,
lamellation, or granular inclusions within the GBM,[3,4] although focal splitting has been described.
Occasionally, individual epidermoid cells possessed lamellar cytoplasmic keratinization or larger compact
lamellations of keratin (keratin pearls) [Figure 1]c.
Inspissated platelike secretions differ morphologically from prostatic corpora amylacea, which are round to oval with concentric
lamellations,[11,12] by their more haphazard shape (rectangular, rhomboid, ovoid) and lack of
lamellations.