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Twitter Poll (April 14, 2021)

sickle cell nephropathy, Crescents
Answer: Crescents   Sickle cell disease is an autosomal recessive disorder classically seen in African-Americans which is caused by a single nucleotide change on chromosome 11p15.5 resulting in an amino acid change from glutamic acid to valine. In the kidney, the disease manifests as sickle cell nephropathy. Histologic features seen in this disease include focal segmental glomerulosclerosis, glomerular enlargement, double contour formation, and hemosiderin deposition within tubular epithelial cells to name a few. Crescent formation is not typically seen in sickle cell nephropathy and if seen would be worrisome for a concomitant process (i.e. ANCA-associated glomerulonephritis).      

Endocarditis-Associated Glomerulonephritis

Endocarditis-Associated Glomerulonephritis, arkana laboratories, renal pathology teaching points
The patient is a 45-year-old IV drug user who presents with fevers, chills, hematuria, and fatigue. On laboratory testing, he was found to have a creatinine of 4.8. Complement levels are depressed and blood cultures are positive. A transesophageal echocardiogram confirmed the presence of endocarditis. A kidney biopsy was obtained due to hematuria. Image 1 and Image 3 shows circumferential cellular crescents with fibrinoid necrosis (many intracapillary neutrophils are seen in image 3). Figure 2 shows severe interstitial fibrosis. Images 4 and 5 show immunofluorescence staining with IgM and C3, respectively. This is a case of endocarditis-associated glomerulonephritis with diffuse...

Chronic Lesions of ANCA – Fibrous Crescent

Fibrous crescents can be differentiated from ischemic obsolescent glomeruli based on the pattern of global sclerosis. The fibrous crescent has interruption of the sclerotic glomerular tuft by fibrosis as is shown in photomicrograph A. By comparison, the ischemic obsolescent glomerulus in photomicrograph B shows a retracted glomerular tuft surrounded (but not transected by) fibrosis.

Crescentic Fibrillary Glomerulopathy

Fibrillary glomerulopathy is a rare disorder of unknown etiology and pathophysiology, which is characterized by deposition of course, randomly-oriented, non-branching fibrils within the mesangium and/or capillary loops. These deposits typically show positive “smudgy” glomerular staining for IgG, C3, kappa and lambda by immunofluorescence. The pattern of glomerular injury by light microscopy is variable; however, mesangial matrix expansion by a PAS-pale, weakly argyrophilic material is almost always present. Cellular crescents (Fig 1 and 2), although uncommon, have been described in up to 17% of cases (see reference).  Given the rarity of this pattern of glomerular injury, its clinical significance is still...