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Currently filtering by tag: Ischemia

Scleroderma

The patient is a 32-year-old African American female who presents with hypertensive urgency, positive ANA, positive anti-RNA polymerase III antibody, schistocytes on the peripheral smear, forgetfulness, and a creatinine of 2. On physical examination, the skin is tight and thickened along the face ("masked face"), back, and proximal arms. Urinalysis shows 250 mg of proteinuria and no active urine sediment. Serologies for c-ANCA, p-ANCA, dsDNA, and anti-GBM are negative. The patient has scleroderma renal crisis. Figure 1 shows an ischemic glomerulus. Figure 2 shows moderate interstitial fibrosis. From low power, the intimal edema and intimal proliferation within the arteries is...

Diagnose This (November 5, 2018)

What renal state do these glomerular changes represent?    ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​  ...

Twitter Poll (May 30, 2018)

ANSWER: C The kidney is the most common organ affected by cholesterol emboli in about 75% of the cases, followed by skin (35-70%), spleen (30-55%), lower gastrointestinal tract (18-48%), eyes (6-25%) and other organs such as brain, thyroid and adrenals (4-20%)   REFERENCES: Fries C, Roos M, Gaspert A, Vogt P, Salomon F, Wüthrich RP, Vavricka SR, Fehr T.  Atheroembolic disease--a frequently missed diagnosis: results of a 12-year matched-pair autopsy study. Medicine (Baltimore). 2010 Mar;89(2):126-32. doi: 10.1097/MD.0b013e3181d5eb39. Scolari, Francesco; Ravani, Pietro. Atheroembolic renal disease. The Lancet;  Vol. 375, Iss. 9726,  (May 8-May 14, 2010): 1650-60. Scolari F, Tardanico R, Zani R, Pola A, Viola BF, Movilli E, Maiorca R. Cholesterol crystal embolism: A...

Papillary Necrosis

This kidney biopsy is from an elderly adult patient with acute renal failure and a history of non-steroidal anti-inflammatory medication (NSAID) use. The dominant finding is papillary necrosis, which has two broad etiologies: medullary ischemia and nephrotoxic agents. Medullary ischemia may occur in patients with diabetes, sickle cell anemia, severe arteriolosclerosis, and volume depletion. Nephrotoxic agents associated with papillary necrosis include NSAIDs and phenacetin. It is not possible to know the extent of involvement based solely on core biopsies. The presence of anuria in such a clinical setting would suggest the possibility of diffuse, bilateral disease.

Global Glomerulosclerosis: Obsolescent Pattern

The image shows two globally sclerotic glomeruli exhibiting the so-called “obsolescent” pattern of glomerular sclerosis. The two key histologic features in this pattern are the shrunken and retracted glomerular capillary tuft (arrowhead) and the fibrous matrix which replaces Bowman’s space (arrow). This pattern of sclerosis is thought to result from reduced glomerular perfusion secondary to arteriosclerosis of small renal arteries. In contrast, the so-called “solidified” pattern of glomerular sclerosis (not shown), in which the entire remnant glomerulus is replaced by fibrous matrix, shows the strongest association with underlying APOL1 risk variants in the setting of chronic kidney disease.