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However, its clinicopathological significance in membranoproliferative glomerulonephritis (MPGN)\u2010pattern glomerular diseases remains unclear. We retrospectively reviewed 50 renal biopsy cases diagnosed as MPGN or MPGN\u2010like glomerulopathy and identified 12 GCM\u2010positive cases for clinicopathological analysis, including Pathologische Anatomie Leiden Endothelium (PAL\u2010E) staining and CD34 immunohistochemistry to assess endothelial injury. Among GCM\u2010positive cases, proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID) was significantly enriched; however, exclusive glomerular IgG3 positivity was consistently observed across other diagnostic categories, irrespective of light\u2010chain restriction. Electron microscopy revealed continuous, irregularly shaped, fine granular subendothelial electron\u2010dense materials with endothelial denudation. PAL\u2010E staining was positive in all evaluable cases, with ultrastructurally identified diaphragmed endothelial fenestrae. Furthermore, CD34 staining demonstrated loss of continuous lining in GCM lesions, suggesting severe endothelial injury. Clinically, all patients presented with nephrotic\u2010range proteinuria, and more than half progressed to end\u2010stage kidney disease or died within 3 years. These findings indicate that GCM\u2010positive MPGN\u2010pattern glomerular diseases represent an aggressive subset associated with IgG3\u2010dominant deposition and severe endothelial injury, with important diagnostic implications.<\/jats:p>","DOI":"10.1111\/pin.70144","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T22:42:59Z","timestamp":1782427379000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Glomerular Capillary Microaneurysms in Membranoproliferative Glomerulonephritis: A Clinicopathological Study Highlighting the Involvement of IgG3"],"prefix":"10.1111","volume":"76","author":[{"given":"Akiko","family":"Mii","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Metabolism and Nephrology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Nephrology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momoko","family":"Arai","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Nephrology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takehisa","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Nephrology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayuko","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Nephrology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Kashiwagi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Nephrology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Kuwahara","sequence":"additional","affiliation":[{"name":"Department of Analytic Human Pathology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arimi","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Analytic Human Pathology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryuji","family":"Ohashi","sequence":"additional","affiliation":[{"name":"Department of Integrated Diagnostic Pathology Nippon Medical School  Bunky\u014d Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8558-0571","authenticated-orcid":false,"given":"Yukinao","family":"Sakai","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Nephrology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Iwabu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Nephrology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4364-9251","authenticated-orcid":false,"given":"Akira","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Analytic Human Pathology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1983.119"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.08.006"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.1998.v31.pm9531171"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1988.193"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2018-09-872028"},{"key":"e_1_2_11_7_1","first-page":"298","article-title":"Glomerular Capillary Aneurysms in Light\u2010Chain Nephropathy. 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