arrow-right-realarrow-right-whitearrow-rightback-to-topdoctordownloadfacebookinstagramlogo-markerlogo-wordmarkpodcastsearchsearch_whitetwitter
Close Modal

Blog


Currently filtering by tag: HIV

Art of Medicine: Plasma Cell Rich Interstitial Nephritis

Plasma Cell Rich Interstitial Nephritis
The above painting shows plasma cell rich interstitial inflammation with lymphocytic and plasma cell tubulitis, findings that can be seen in plasma cell rich interstitial nephritis.  Acute interstitial nephritis can have an inflammatory infiltrate with lymphocytes, plasma cells, eosinophils, neutrophils, and/or histiocytes.  Greater than 10 percent plasma cells would be considered “plasma cell rich”.  An H & E stained section of a plasma cell rich infiltrate is shown below. The differential diagnosis for a plasma cell rich interstitial nephritis in native kidney biopsies includes drug reactions, Sjögren's syndrome, chronic pyelonephritis, and IgG4-related kidney disease.  IgG4-related kidney disease is characterized by...

HIVAN

This biopsy is taken from a patient with HIV/AIDS who presented with an elevated serum creatinine and nephrotic range proteinuria.  Key morphologic features associated with HIV-related kidney disease include collapsing glomerular lesions, microcystic tubular dilatation and variable tubular epithelial injury, and interstitial inflammation and edema (see Fig 1-3).  In addition to these findings, other kidney diseases seen in patients with HIV include the following:  HIV immune complex kidney disease (HIVICK), various other immune complex diseases (e.g. hepatitis C virus, membranous glomerulopathy), HIV-associated lupus-like glomerulonephritis, thrombotic microangiopathy, and various renal tumors (e.g. Kaposi sarcoma, lymphoma).

Diagnose This (July 16, 2018)

What is your diagnosis in this native kidney biopsy? And for bonus points, what do you suspect is the underlying etiology of the diagnosis?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​...

Diagnose This! (January 22, 2018)

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

Diagnose This! (October 9, 2017)

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

Malakoplakia

An adult patient in the mid-fifties with a deceased donor renal transplant for three years (primary disease “hypertensive nephrosclerosis”) presented with a low-grade fever and a rising creatinine. Urinalysis showed hematuria and proteinuria. A transplant biopsy was performed. 1. Low power showing one relatively intact core and a second core showing diffuse replacement of the usual renal parenchyma by inflammation and fibrosis (Trichrome, 40x) 2. Mixed inflammatory cell infiltrate (Jones Silver, 400x) 3. Macrophages with PAS-positive granules (PAS, 400x) 4. Michaelis-Gutmann body (H&E, 400x 5. Michaelis-Gutmann body (H&E, original magnification 600x) 6. Von Kossa Positive Michaelis-Gutmann bodies (von Kossa, 400x)...

Tenofovir

A wide variety of prescription and over the counter drugs may cause toxic injury to the renal tubular epithelium. Given the morphologic overlap of acute tubular injury secondary to different etiologic agents, determination of the offending drug is usually not possible by morphology alone and clinico-pathological correlation is often, if not always, needed. However, there are certain drugs that yield a quite characteristic pattern of injury which enables the pathologist to suggest a possible etiology. Such is the case of tenofovir, a nucleotide analog reverse-transcriptase inhibitor frequently used to treat and prevent HIV infection. Histologic findings in patients with tenofovir-associated...