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Currently filtering by tag: Hyaline thrombi

Cryoglobulinemic Glomerulonephritis

Acute kidney injury, chryoglobulinemia, glomerulonephritis, hyaline thrombi, masked deposits, paraffin immunofluorescence, Cryoglobulinemic Glomerulonephritis
The patient is a 60-year-old male who presents with proteinuria, hematuria, and a creatinine of 2.8 mg/dL. He was in his normal state of health until 2 weeks ago when he noticed he was having trouble putting on his shoes. Serologies show low complements and an albumin of 2.3 g/dL. Serologies for ANA, c-ANCA, p-ANCA, hepatitis B, and hepatitis C are negative. No monoclonal spike is found on serum electrophoresis. Figure 1 shows accentuation of lobulation with both mesangial and endocapillary hypercellularity. This is a membranoproliferative pattern. Figure 2 shows a small, hyaline thrombus. Figure 3 shows moderate interstitial fibrosis....

Lupus Nephritis (Class IV)

Lupus Nephritis, arkana laboratories, teaching point, nephropathology
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...

Pushing Glass (September 7, 2017)

type 1 cryoglobulinemia, renal biopsy, kidney disease, arkana laboratories, pushing glass
The patient is a 75-year-old female who presents with proteinuria and a creatinine of 2.50. She has chronic lymphocytic leukemia, hypertension, and multiple sclerosis. What is the best diagnosis? A. Type I Cryoglobulinemia B. Type II Cryoglobulinemia C. Hepatitis C associated MPGN D. C3 Glomerulonephritis   The best answer is A (type 1 cryoglobulinemia). The biopsy shows a membranoproliferative pattern with IgG lambda restriction. The presence of hyaline thrombi is concerning for cryoglobulinemia. Cryoglobulins are immunoglobulins that precipitate in the cold and dissolve on warming and induce disease via vascular injury and blockage. Three types of cryoglobulins are distinguished based...

Twitter Post (August 30, 2018)

ANSWER: B Type II (mixed) cryoglobulinemia is characterized by immune-complexes containing a monoclonal Ig (usually IgM) that have an RF activity and polyclonal Ig (usually IgG). It’s most commonly caused by HCV, with some cases caused by lymphoproliferative or autoimmune disorders. References: Zaidan M, et al. Spectrum and prognosis of noninfectious renal mixed cryoglobulinemic GN. J Am Soc Nephrol 2016; 27:1-12. Fabrizi F, et al. Hepatitis C virus infection, mixed cryoglobulinemia, and kidney disease. Am J Kidney Dis 2013; 61(4): 623-637.