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

Blog


Currently filtering by tag: Hyaline Pseudothrombi

Diagnose This (August 26, 2019)

Sjögren Syndrome, Diagnose This, Arkana Laboratories, renal pathology
What is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​ ​  ...

Hep C-Associated Cryoglobulinemic Glomerulonephritis

This biopsy was performed on a 66-year-old Caucasian male with a history of hepatitis C, who presented with nephrotic range proteinuria (UPC 4.2 g/g), hematuria and increased creatinine (2.5 mg/dl). C3 is 7 mg/dl and C4 <2 mg/dl. The glomerulus shows a membranoproliferative pattern of glomerular injury characterized by mesangial matrix expansion and hypercellularity, associated with endocapillary proliferation, segmental capillary loop double contour formation and accentuation of the lobular architecture (Fig 1&2).  Furthermore, the capillary lumens show frequent, large, PAS-positive pseudothrombi (Fig 1). Immunofluorescence (not shown) is positive in a mesangial and global capillary wall pattern for IgG (1+), IgM...

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...

Diagnose This! (November 20, 2017)

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

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...