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Archive: October 2017

Acute Pyelonephritis

This renal biopsy from a 65-year-old male with a history of E. Coli urinary tract infection and bacteremia shows severe neutrophil-rich interstitial inflammation with neutrophilic rimming of the tubules, neutrophilic tubulitis and neutrophilic casts (Figures 1-3).  These features are diagnostic of acute pyelonephritis. In addition to the aforementioned morphologic findings, a characteristic feature of acute pyelonephritis is the patchy nature of the infiltrate (Fig 4). Relatively spared areas of renal parenchyma are often intermixed with areas displaying severe tubulointerstitial inflammation.  While an ascending urinary tract infection is the main mechanism for the development of acute pyelonephritis, hematogenous infections may also...

Diagnose This! (October 30, 2017)

What is your diagnosis?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​ ​...

Wellness Coaches

It’s always a pleasure when our Journey2Health friends are in town! Jeanine and Sarah came for a quick lunch and lecture today.

Lysozyme

A 76-year-old Caucasian male with renal failure underwent renal biopsy. He had a serum creatinine of 2.1 mg/dl and a urine protein/creatinine ratio of 0.3.  SPEP showed hypergammaglobulinemia with a polyclonal increase, no monoclonal proteins were identified.  The patient has a past medical history of Chronic myelomonocytic leukemia (CMML). Despite the lack of significant proteinuria, the renal biopsy is characterized by proximal tubules that are stuffed with numerous brightly eosinophilic and silver negative protein resorption droplets (A). The droplets are weakly PAS-positive and strongly positive for lysozyme (B and C). These findings are consistent with lysozyme nephropathy. This is a...

Arkanines: Raisin

The #Arkanines pack lost one of its own last week. Meet Raisin. She belonged to Tracy, our HR person. Sundays were Raisin’s favorite because her friend Gail Walker would feed her table scraps after church. Fireworks were her only nemesis. She was thrilled to afford any stranger she encountered the privilege of petting her, and she never thought they took full advantage of her generosity. Her sweet presence and companionship will be missed by many.

Light Chain Proximal Tubulopathy

Light chain proximal tubulopathy (LCPT) is a disease characterized by the renal biopsy finding of cytoplasmic light chain restriction within the proximal tubule cells. It has traditionally been known for the presence of Fanconi syndrome though this is not present in the majority of cases in more recent case series.1,2 There is a morphologic spectrum to the disease. Most notably, it can occur with or without crystalline inclusions in the proximal tubule cytoplasm. The photomicrographs here show lambda restriction in the proximal tubule cytoplasm in a case without evidence of crystal formation by light and electron microscopy. When there is evidence...

Cryoglobulinemic Deposits by EM

Electron microscopy can be helpful in the diagnosis of cryoglobulinemic glomerulonephritis. This renal biopsy (Fig. 1) shows a membranoproliferative pattern glomerulonephritis in which the extent of endocapillary hypercellularity and glomerular capillary double contour formation is nicely highlighted with a Jones silver stain. The patient had a long history of hepatitis C infection, and you can clearly see intraluminal hyaline thrombi – “pseudothrombi” – in some capillary lumens, which are a helpful clue in diagnosing cryoglobulinemic glomerulonephritis. Some cases of cryoglobulinemic glomerulonephritis show electron dense deposits with organized substructure (Fig. 2), including tubular, fibrillar, crystalloid, or even fingerprint-like patterns. Early work...

Alport Syndrome

This biopsy from a 22-year-old Hispanic male with a history of hematuria, subnephrotic proteinuria, and chronic kidney disease shows essentially unremarkable glomeruli (Fig 1) with moderate interstitial fibrosis and tubular atrophy, and frequent interstitial foam cells (Fig 2).  Furthermore, electron microscopy shows irregular glomerular basement membranes (GBM) that vary between thick and thin, along with segmental lamellation and diffuse epithelial foot process effacement (Fig 3).  These findings, along with the clinical history are consistent with Alport syndrome. Alport syndrome is a spectrum of diseases affecting the synthesis of type IV collagen, which is the main component of the glomerular basement...