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Currently filtering by tag: Hemoglobin cast nephropathy

Hemoglobin Casts

This 58-year-old African American male without significant past medical history presents with fatigue and weakness. During workup, he was found to have anemia, mild thrombocytopenia, elevated LDH, low haptoglobin and acute kidney injury. The serum creatinine at presentation was 5.5 mg/dl. A renal biopsy was performed and shows acute tubular injury with numerous granular and globular eosinophilic (Fig 1) and fuchsinophilic casts (Fig 2) within the tubular lumens. A myoglobin immunoperoxidase stain is negative (not shown) and a hemoglobin stain is diffusely positive within the pigmented casts. Otherwise, the glomeruli and vessels appear normal, without evidence of microangiopathy. These findings...


The H&E photomicrographs show acute tubular injury with eosinophilic ‘beaded’ casts (arrow). Immunohistochemical stains were strongly positive hemoglobin in the casts (pictured here) while myoglobin was completely negative. These findings are consistent with hemoglobin cast nephropathy and indicate the presence of intravascular hemolysis. The morphologic lesions present in hemoglobin cast nephropathy are indistinguishable from myoglobin cast nephropathy without immunohistochemical analysis. It is important when staining for suspected hemoglobin cast nephropathy to stain for both hemoglobin and myoglobin as positive hemoglobin staining in a myoglobin cast is commonly present and considered nonspecific. However, the converse is not true and hemoglobin casts...