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Currently filtering by tag: Cholesterol

Interstitial Eosinophils

Prominent interstitial eosinophils (see arrow) are most often associated with allergic-type acute interstitial nephritis (AIN).  However, eosinophils are not specific for allergic-type AIN as they may also be prominent in other acute and chronic diseases affecting the tubulointerstitium.  Diabetic patients, for example, may have prominent interstitial eosinophilic aggregates, which are usually not associated with medication use or a history of allergy (see Dai DF et al.  Interstitial eosinophilic aggregates in diabetic nephropathy: allergy or not? Nephrol Dial Transplant. 2015 Aug;30(8):1370-6).  Remember, too, that urine eosinophils can be found in a variety of upper and lower urinary tract diseases as well,...

Cholesterol Microemboli

Cholesterol emboli involving the kidney may manifest clinically as acute kidney injury, hematuria, proteinuria (both non-nephrotic and nephrotic range), and even new-onset hypertension. This biopsy illustrates a rare example of glomerular involvement (Fig. 1). Most emboli are identified “upstream” within interlobular and/or arcuate arteries (Fig. 2). Prior to this biopsy, the patient had recently undergone an arterial catheterization procedure. Lusco MA, et al. AJKD Atlas of Renal Pathology: Cholesterol Emboli. Am J Kidney Dis. 2016 Apr; 67(4):e23-4. PMID: 27012950.

Atheroemboli

A PAS section shows an atheroembolus occluding an artery (arrow) with an adjacent ischemic appearing glomerulus. Atheroemboli appears as slit-like spaces in sections cut from formalin fixed paraffin-embedded sections due to the fact that the cholesterol crystals are dissolved by the lipid solvents during processing. However, as demonstrated here, the crystals can be visualized by their birefringence under polarized light in the cryosections for immunofluorescence evaluation. Atheroembolization is often preceded by in an invasive vascular procedure such as coronary artery bypass or aortic aneurysm repair though they can also be precipitated by trauma and are often idiopathic. Systemic manifestations that...

Pushing Glass (September 6, 2017)

A 70-year-old man undergoes kidney biopsy because of worsening renal function. His medical history is otherwise significant for hyperlipidemia, type II diabetes mellitus, hypertension, gout, coronary artery disease, s/p CABG 10 years ago and congestive heart failure. Serum creatinine is 6 mg/dl. Serological studies are negative. Urinalysis shows proteinuria of up to 1.5 g/day. What is the most potentially correctable factor contributing to his worsening of renal function? a. Diabetic glomerulosclerosis b. Atheroembolism c. Uric acid nephropathy d. Hypertensive arteriosclerosis e. Interstitial nephritis The answer is B. Atheroembolism.  At low magnification, this biopsy shows features of advanced interstitial fibrosis and...

Atheroemboli

A PAS section shows an atheroembolus occluding an artery (arrow) with an adjacent ischemic appearing glomerulus. Atheroemboli appear as slit-like spaces in sections cut from formalin fixed paraffin-embedded sections due to the fact that the cholesterol crystals are dissolved by the lipid solvents during processing. However, as demonstrated here, the crystals can be visualized by their birefringence under polarized light in the cryosections for immunofluorescence evaluation. Atheroembolization is often preceded by in an invasive vascular procedure such as coronary artery bypass or aortic aneurysm repair though they can also be precipitated by trauma and are often idiopathic. Systemic manifestations that...

Diagnose This! (May 8, 2017)

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