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Currently filtering by tag: Hematuria

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...

Digging Deeper, or How We Never Quit

We received the biopsy from a 25-year-old female who presented for evaluation of nephrotic range proteinuria.  Lab evaluation reveals a creatinine of 0.55 and 24-hour urine protein is 3.6 g.  Serologies were negative or normal for ANA, hepatitis B, hepatitis C, HIV, and complement levels.  There was no history of hypertension or diabetes. A biopsy was performed to evaluate the source of proteinuria. Two cores of renal tissue were sampled on light microscopy evaluation.  They consisted mostly of medulla, and only two glomeruli were seen in multiple sections. The glomeruli have capillary loops with attenuated contours. The capillary loops appeared...

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...

Diagnose This (January 28, 2019)

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

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 nephropathy with something extra…

The biopsy is from a 61-year-old man with a history of intermittent microscopic hematuria for many years who presents with recent 18-pound weight loss and nephrotic syndrome.  His creatinine is mildly elevated at 1.3 mg/dL.  He has 12.5 g of proteinuria and his serum albumin is 2.6 mg/dL.  The biopsy shows diffuse mild mesangial matrix expansion with no necrosis or proliferative lesions (Fig. 1).  Immunofluorescence microscopy shows extensive granular mesangial IgA deposits (3+) (Fig. 2), compatible with IgA nephropathy.  Interestingly, the Jones methenamine silver stain also shows argyrophilic spikes involving capillary loops, which are most suggestive of spicular amyloid deposits...