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Currently filtering by tag: Cryoglobulinemic glomerulonephritis

Diagnose This (August 26, 2019)

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

Diagnose This (July 9, 2018)

What is your diagnosis in this native kidney biopsy?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​...

Pushing Glass (January 12, 2018)

A 70-year-old female presents with 8 grams of proteinuria and a creatinine of 2.1. She relays that she has noticed a gradual increase in swelling over the last 6 months. She denies NSAID use and any new exposures. What is the best diagnosis? A. Cryoglobulinemia B. IgA Nephropathy C. Post-infectious Glomerulonephritis D. Thrombotic Microangiopathy The best answer is A – cryoglobulinemia. The photographs show a membranoproliferative glomerulonephritis with numerous hyaline thrombi. The hyaline thrombi stain for IgM, IgA, kappa, and lambda. The best diagnosis is cryoglobulinemia. IgA nephropathy is a consideration, but IgA nephropathy typically has mesangial staining and usually...

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...

Cryoglobulinemic Glomerulonephritis

Figure 1: PAS-stained section showing a glomerulus with a membranoproliferative pattern of glomerular injury characterized by mesangial matrix expansion and hypercellularity, associated with endocapillary proliferation, glomerular basement membrane double contour formation and accentuation of the lobular architecture. Furthermore, the capillary loops show frequent, large, PAS-positive pseudothrombi, highly suspicious for cryoglobulinemic glomerulonephritis. Cryoglobulins are circulating immunoglobulins that precipitate at 4°C and redissolve at 37°C. They are classified into three types according to the immunochemical composition of the immunoglobulins. Type I cryoglobulins are composed of a single monoclonal immunoglobulin, usually IgM, and are commonly associated with lymphoproliferative disorders such as Waldenstrom macroglobulinemia,...

Pushing Glass (March 22, 2017)

A 71-year-old woman with a history of multiple myeloma, hypertension and vitamin D deficiency presented with decreased renal function. Investigations show serum creatinine increased to 3.36 mg/dL. Serum albumin is 2.6 gm/dL. Twenty-four hour urinary protein is 2.8 gm/day. These images show characteristic findings of which of the following diseases: A) Thrombotic microangiopathy B) Cast nephropathy C) Light chain deposition disease D) Cryoglobulinemic glomerulonephritis E) Amyloidosis F) Fibrillary glomerulopathy Answer: D The images show intracapillary hyaline, thrombi which are weakly PAS-positive, and stain red on silver and trichrome stains. These showed positive staining only for IgG1 and kappa light chain....