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Currently filtering by tag: Acute kidney injury

Art of Medicine: ANCA-Associated Glomerulonephritis

The painting above shows a crescentic glomerulonephritis and necrotizing arteritis.  A mixed interstitial inflammatory infiltrate is shown in the top left corner, and tubules are dilated with a few red blood cell casts.  This cluster of findings can occur in ANCA-associated disease.  Renal biopsy images representing manifestations of ANCA-associated glomerulonephritis are shown below.  The main differential diagnosis for crescents within glomeruli includes immune complex glomerulonephritides, anti-GBM nephritis, and ANCA-associated glomerulonephritis (pauci-immune), although nearly any glomerulonephritis with mesangial and/or endocapillary proliferation can produce crescents (examples – infection-associated glomerulonephritis, fibrillary glomerulonephritis, and others).  Correlation with ANCA serologies is recommended in any case...

Hemosiderosis

An 80-year-old white male presents with a creatinine of 4.2 (baseline 1.1) on routine lab examination. His medical history is significant for coronary artery disease, aortic valve replacement, hypertension, and peripheral artery disease. He reports no episodes of dehydration and reports that he has been in his normal state of health. Figure 1 shows a normal glomerulus. Figure 2 shows a mild interstitial fibrosis. Figure 3 shows brown spherules within the tubular epithelial cells. Figure 4 confirms the presence of iron within these brown spherules. This is a case of renal hemosiderosis. The presence of iron deposits speaks towards intravascular...

Lupus Nephritis (Class IV)

A 20-year-old female presents with hematuria, proteinuria, and a creatinine of 1.2 mg/dl. Serologies for ANA are positive. Complement levels are decreased. She states that auto-immune disease runs in her family, but is unsure about any specific diagnosis. Serologies for dsDNA, SSA, SSB, rheumatoid factor, hepatitis B, hepatitis C, and HIV are pending. Figure 1 shows mesangial and endocapillary hypercellularity with prominent "hyaline thrombi." Figure 2 shows no significant interstitial fibrosis. Figure 3 shows "wire loops" and no "spikes" and "holes." Figure 4, Figure 5, and Figure 6 shows mesangial and capillary staining with IgG, kappa, and lambda, respectively. Figure...

Renal Oxalosis

A 25-year-old female presents to the hospital with malaise and a creatinine of 3.5. She reports that she was in her normal state of health until about 2 weeks ago when she had the “flu.” The patient has minimal proteinuria and bland urine sediment. A kidney biopsy was obtained. Figure 1 shows a normal glomerulus. Figure 2 shows severe chronicity. Figure 3 and 4 show polyhedral clear crystals within the tubular lumina. Figure 5 shows an increased number of oxalate crystals under polarized light. Renal oxalosis is characterized by excess deposition of calcium oxalate crystals within the kidney. There are...

Minimal Change Disease

A 70-year-old female presents with nephrotic range proteinuria. She had been in her regular state of health until 2 weeks ago when she noticed swelling in her ankles and that her shoes no longer fit. She went to her family practitioner who sent her to a cardiologist to rule out congestive heart failure. Her troponin levels were normal and her creatinine on routine examination was 7.5 mg/dL. She was admitted to the hospital and an emergent kidney biopsy was requested. Figure 1 shows a normal glomerulus. Figure 2 shows no significant interstitial fibrosis. Figure 3 shows severe arteriosclerosis. Figure 4...

Diagnose This (January 21, 2019)

A limited sample showed this lesion and negative staining on paraffin-retrieved IF tissue. What is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​...

Digging Deeper – Here, There, and Everywhere

This biopsy came from an elderly gentleman in his 80s, who presented with acute renal failure.  His serum creatinine had increased from a baseline of 1.3 mg/dL up to 6.6 mg/dL.  And in addition to that, urinalysis was positive for proteinuria and blood.  His medical history included pulmonary embolism, BPH, gastrointestinal hemorrhage and GERD.  Multiple serologies were ordered upon presentation, and among these, pANCA and MPO were markedly positive.  A biopsy was performed to investigate the possibility of an ANCA-mediated crescentic glomerulonephritis. Unfortunately, the material obtained for biopsy was small in size, and the longest core, submitted to light microscopy,...

Infection-Associated Glomerulonephritis

A 60-year-old male presents with a painful left hip, hematuria, and a creatinine of 1.5 mg/dl. He was recently hospitalized due to fever and chills. It was found that his left hip implant was infected. Blood cultures grew out methicillin-resistant Staphylococcus aureus. After beginning treatment with antibiotics and planning for surgery, a nephrology consult was requested. A kidney biopsy was performed and serologies were ordered. Figure 1 shows segmental endocapillary hypercellularity. Figure 2 shows mild interstitial fibrosis. Figure 3 shows staining with C3 only. All other immunofluorescence stains were negative on the frozen tissue. Immunofluorescence was then performed on the...

IgA Dominant Infection-Associated Glomerulonephritis

A 65-year-old male presents to the ER with a new onset rash and blood in his urine. The ER doc is worried about an allergic reaction and on chem 7 finds that the patient’s creatinine is 6.5 mg/dl. The patient has been a diabetic for over 20 years and had been diagnosed with cellulitis of his left foot a week ago by a family practice physician who gave him antibiotics. A skin biopsy of the new onset rash during this hospitalization shows a leukocytoclastic vasculitis with IgA deposition. A kidney biopsy is requested. The kidney biopsy shows nodular diabetic glomerulosclerosis...

Diagnose This (December 10, 2018)

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