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Currently filtering by tag: Hypertension

Twitter Poll (November 15, 2018)

Number of Nephrons in kindey biopsy
ANSWER: A The number of nephrons in the normal kidney is important because they may play a role in the development of hypertension and progression of chronic renal disease. Nephron number is influenced by many factors that affect renal development. References: 1. Luyckx VA, Brenner BM. The clinical importance of nephron mass. J Am Soc Nephrolo 2010;21:898-910. 2. Bertram JF, Douglas-Denton R, et al. Human nephron

Ask-Upmark

This kidney biopsy is from a 16-year-old boy with a history of chronic reflux nephropathy. Imaging findings showed unilateral segmental cortical scarring. Although regions of the biopsy show intact renal cortex with normal appearing glomeruli and tubules (Fig. 1), well-demarcated adjacent cortical segments are aglomerular and show severe tubular dropout and interstitial fibrosis (Fig. 2). No definite dysplastic features are noted. This pattern of renal injury supports the clinical impression of unilateral segmental renal hypoplasia (Ask-Upmark kidney). Vesicoureteral reflux is thought to be the main cause of injury in an Ask-Upmark kidney. The condition was first described by the Swedish...

Cholesterol Microemboli

Cholesterol emboli involving the kidney may manifest clinically as acute kidney injury, hematuria, proteinuria (both non-nephrotic and nephrotic range), and even new-onset hypertension. This biopsy illustrates a rare example of glomerular involvement (Fig. 1). Most emboli are identified “upstream” within interlobular and/or arcuate arteries (Fig. 2). Prior to this biopsy, the patient had recently undergone an arterial catheterization procedure. Lusco MA, et al. AJKD Atlas of Renal Pathology: Cholesterol Emboli. Am J Kidney Dis. 2016 Apr; 67(4):e23-4. PMID: 27012950.

Pushing Glass (August 8, 2017)

A 69-year-old man with past medical history of hypertension presents with nephrotic syndrome and 7 gm/day proteinuria. Serological studies are negative for hepatitis B and C. The images are characteristic findings of which of the following: 1. Amyloidosis 2. Fibrillary Glomerulopathy 3. Light chain deposition disease 4. Diabetic nephropathy 5. Fibronectin glomerulopathy This is a case represents classic findings of fibrillary glomerulopathy. Fibrillary glomerulopathy has been found to be associated with hepatitis C infection, malignancy, dysproteinemia and autoimmune disease (see References below). The deposits in fibrillary glomerulopathy are weakly PAS-positive, silver negative and Congo red negative. By electron microscopy, there...

Thrombotic Microangiopathy

The image (trichrome stain) shows the characteristic arteriolar lesion of acute thrombotic microangiopathy. Note the prominent mucoid intimal edema and extensive red blood cell fragmentation. The differential diagnosis based on this morphologic lesion is broad, and it includes infection, accelerated hypertension, antiphospholipid antibody syndrome, and malignancy, among others. The kidney biopsy was from a 75-year-old Caucasian woman seen in consultation for acute renal failure and hypertension which developed one week after the onset of severe diarrhea. Laboratory tests showed microangiopathic hemolytic anemia, and stool cultures were positive for Shiga toxin-producing E. coli. Hepatitis, ANA, anti-glomerular basement membrane, and ANCA tests...

Diffuse Mesangial Hypercellularity

This biopsy is from a previously healthy 3 year old female, who presented with sudden onset nephrotic syndrome, hypertension and microscopic hematuria. Light microscopy shows greater than 4 cells per mesangial region in most glomeruli (Fig 1), with absence of segmental glomerulosclerosis. Immunofluorescence is completely negative and electron microscopy shows diffuse epithelial foot process effacement (Fig 2). The findings are consistent with minimal change disease with diffuse mesangial hypercellularity. This pattern of injury is considered a variant of minimal change disease. Patients with diffuse mesangial hypercellularity have a higher risk of initial resistance to steroid therapy; however, it is not...

Pushing Glass (May 16, 2017)

A 15-year-old boy had a kidney biopsy because of the persistent nephrotic syndrome. His medical history is significant for resolved intermittent asthma. In late September 2016, he developed a viral syndrome with a runny nose, congestion, sore throat, vomiting, and diarrhea. Over the next one to two weeks, he developed generalized edema, most prominent in the lower extremities and belly. He was diagnosed presumptively with acute glomerulonephritis and treated accordingly. His condition continued to worsen with the persistent nephrotic syndrome and acute hypertension. Laboratory investigations show a serum creatinine of 1.35 mg/dL. Serum albumin is 1.9 g/dL. Urinalysis shows 3+...

Arteriosclerosis

A very common vascular histologic finding in patients with hypertensive nephrosclerosis is arteriosclerosis. In advanced lesions, such as this example, there is prominent intimal fibrosis with narrowing of the vessel lumen. The replacement of smooth muscle cells in the tunica media by fibrous tissue is thought to result from collagen and elastic tissue synthesis by myointimal cells. The degree of intimal fibrosis is thought to be more closely associated with elevated blood pressure than the degree of hyaline arteriolosclerosis.

Pushing Glass (April 4, 2017)

The patient is a 30-year-old female who presents with nephrotic range proteinuria and a creatinine of 2.5. She has a history of hypertension and joint pains. Serologies for ANA, dsDNA, and ANCA are negative. What is the best diagnosis? A. ANCA-associated Glomerulonephritis B. C3 Glomerulonephritis C. Membranous-like Glomerulopathy with Masked IgG Kappa Deposits D. Proliferative Glomerulonephritis with Monoclonal IgG Kappa Deposits The best answer is C: Membranous-like Glomerulopathy with Masked IgG Kappa Deposits. An ANCA-associated glomerulonephritis is a possibility with the fibrous crescent and weak direct immunofluorescence staining. However, the ANCA is negative and the immunofluorescence stains are “unmasked” on...

Pushing Glass (March 22, 2017)

A 71-year-old woman with a history of multiple myeloma, hypertension and vitamin D deficiency presented with decreased renal function. Investigations show serum creatinine increased to 3.36 mg/dL. Serum albumin is 2.6 gm/dL. Twenty-four hour urinary protein is 2.8 gm/day. These images show characteristic findings of which of the following diseases: A) Thrombotic microangiopathy B) Cast nephropathy C) Light chain deposition disease D) Cryoglobulinemic glomerulonephritis E) Amyloidosis F) Fibrillary glomerulopathy Answer: D The images show intracapillary hyaline, thrombi which are weakly PAS-positive, and stain red on silver and trichrome stains. These showed positive staining only for IgG1 and kappa light chain....