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Currently filtering by tag: Infection-associated glomerulonephritis

Art of Medicine: Proliferative Glomerulonephritis

Article
Proliferative Glomerulonephritis
The above painting shows endocapillary hypercellularity with mononuclear cells and neutrophils, as well as hyaline deposits within glomeruli.  Red blood cell casts are seen within focal tubular lumens, and the tubules are widely spaced due to interstitial edema and inflammation.  These findings can be seen within acute proliferative glomerulonephritis.  Other proliferative changes within glomeruli seen in acute proliferative glomerulonephritis include mesangial hypercellularity and crescent formation. The differential diagnosis for proliferative glomerulonephritis is broad and includes infection-associated glomerulonephritis including post-streptococcal glomerulonephritis, focal or diffuse lupus nephritis, shunt nephritis, cryoglobulinemic glomerulonephritis, hepatitis-associated glomerulonephritis, and IgA nephropathy (or Henoch-Schonlein purpura nephritis).   Other considerations...
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Disease Week: Infection-Associated Glomerulonephritis and Endocarditis-Associated Glomerulonephritis

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Infection-Associated Glomerulonephritis and Endocarditis-Associated Glomerulonephritis, Disease Week, Arkana Laboratories
Monday Renal disease related to infective endocarditis was first reported over 100 years ago. However, the initial literature describing nephritis associated with infective endocarditis relied primarily on autopsy-based studies from the pre- and early post-antibiotic era.  Reviews from recent decades note the evolution in renal complications of infectious diseases. Demographics have changed from younger to older patients. The frequency of comorbidities including diabetes has increased.  Recent decades have seen a change in the infectious agents that cause renal disease, from primarily Streptococcal to a broader array of organisms compared to the past, with predominance of Staphylococci. The historical division into...
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Infection-Associated Glomerulonephritis

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Infection-Associated Glomerulonephritis
A 60-year-old male presents with a painful left hip, hematuria, and a creatinine of 1.5 mg/dl. He was recently hospitalized due to fever and chills. It was found that his left hip implant was infected. Blood cultures grew out methicillin-resistant Staphylococcus aureus. After beginning treatment with antibiotics and planning for surgery, a nephrology consult was requested. A kidney biopsy was performed and serologies were ordered. Figure 1 shows segmental endocapillary hypercellularity. Figure 2 shows mild interstitial fibrosis. Figure 3 shows staining with C3 only. All other immunofluorescence stains were negative on the frozen tissue. Immunofluorescence was then performed on the...
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IgA Dominant Infection-Associated Glomerulonephritis

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IgA Dominant Infection-Associated Glomerulonephritis, renal pathology
A 65-year-old male presents to the ER with a new onset rash and blood in his urine. The ER doc is worried about an allergic reaction and on chem 7 finds that the patient’s creatinine is 6.5 mg/dl. The patient has been a diabetic for over 20 years and had been diagnosed with cellulitis of his left foot a week ago by a family practice physician who gave him antibiotics. A skin biopsy of the new onset rash during this hospitalization shows a leukocytoclastic vasculitis with IgA deposition. A kidney biopsy is requested. The kidney biopsy shows nodular diabetic glomerulosclerosis...
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Diagnose This (June 11, 2018)

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What is this finding and what is it classically associated with?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​  ...
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Diagnose This (April 2, 2018)

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What is the most likely diagnosis?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​ ​   ​...
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Subepithelial Humps

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The depicted electron micrograph shows numerous, large and irregular subepithelial deposits which protrude from the glomerular basement membrane towards the urinary space. The deposits are overlaid by significant epithelial foot process effacement and they lack definitive substructure. This type of deposits has historically been described as “hump-like”. While they are most commonly seen in the setting of infection-associated glomerulonephritis, they are by no means specific, and may be seen in other entities, such as C3 glomerulonephritis. When scarce, these deposits may be limited to the hinge region of the glomerulus. Over time, subepithelial hump-like deposits may become electron-lucent and eventually...
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Infection-Associated GN

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This kidney biopsy was performed on a 63-year-old female with a history of hypertension, congestive heart failure, lower extremity edema and right leg ulcers with cellulitis. The serum creatinine is 3.1 mg/dl, the UPC is 0.9 g/g and C3 levels are low. Urinalysis shows moderate blood and a small amount of protein. By light microscopy, the glomeruli are enlarged and show diffuse and global endocapillary hypercellularity with increased neutrophils (Fig 1 – H&E and Fig 2 - Jones). Immunofluorescence shows isolated C3 deposits within the mesangium and peripheral capillary loops (Fig 3). No evidence of immunoglobulin deposition was present on...
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Acute Postinfectious Glomerulonephritis

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These renal biopsy images are from an 8-year-old boy who experienced the abrupt onset of hypertension, lower extremity edema, gross hematuria, and proteinuria about one week after seeing his pediatrician for a sore throat. The child had an elevated BUN and serum creatinine, and he was hypocomplementemic (C3). Figure 1 shows a diffuse proliferative (note the hypercellularity and closed capillary loops) and exudative (note the abundant neutrophils) glomerulonephritis. The Jones silver stain in Figure 2 confirms the presence of endocapillary, mesangial, and extracapillary hypercellularity. The immunofluorescence studies in Figure 3 show coarse, granular immune deposits along the peripheral capillary loops...
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Infective Endocarditis-Associated Glomerulonephritis

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This renal biopsy was taken from a 35 year old male with history of intravenous drug abuse and MRSA tricuspid valve endocarditis, who developed acute kidney injury (Cr 4.7 mg/dl) and hematuria.  The biopsy shows focal and segmental necrotizing and crescentic lesions involving approximately 10% of the available glomeruli (Fig 1 and 2). Additionally, there is severe acute tubular injury with numerous red blood cell casts (Fig 3). Immunofluorescence (not shown) reveals weak immune complex deposition within the spectrum of pauci-immune disease (IgA= 1+; IgM= trace; C3= 1+; Kappa= trace; lambda= 1+), and no definitive deposits were evident by electron...
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Announcement

Posted December 28th 2020
We are now offering IHC and ISH testing for evaluation of the presence of SARS-CoV-2 (aka COVID-19 and novel 2019 coronavirus).
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