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Currently filtering by tag: Minimal change disease

Art of Medicine: Minimal Change Disease

The above painting shows podocytes with foot processes extending along the glomerular basement membrane of neighboring capillary loops.  Effacement of podocyte foot processes occurs in primary podocytopathies, including minimal change disease (see electron photomicrograph below). Minimal change disease is the most common etiology of idiopathic nephrotic syndrome in children and is the third most common cause in adults, after focal segmental glomerulosclerosis and membranous glomerulopathy.  A majority of cases are “primary”, require no additional workup, and are due to a circulating permeability factor.   Several possible secondary causes have also been identified.  Although these are rare, these should be considered in...

Diagnose This (April 22, 2019)

What is this finding and what diagnoses does it imply?       ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​    ...

Twitter Poll (January 23, 2019)

ANSWER: A Although glomerular disease in patients with CLL/SLL is less common, the most frequent patterns of glomerular injury seen include MPGN (immune complex mediated), MCD, membranous GN, and monoclonal immunoglobulin deposition disease. The most common form of kidney involvement in patients with CLL/SLL is the presence of direct infiltration of the kidney parenchyma by leukemic cells. Although glomerular disease in patients with CLL/SLL is less common, they can be present.  The glomerular pattern of injury frequently seen in these group of patients include membranoproliferative glomerulonephritis (immune complex mediated), minimal change disease, membranous nephropathy, and monoclonal immunoglobulin deposition disease (nonamyloid...

Minimal Change Disease

A 70-year-old female presents with nephrotic range proteinuria. She had been in her regular state of health until 2 weeks ago when she noticed swelling in her ankles and that her shoes no longer fit. She went to her family practitioner who sent her to a cardiologist to rule out congestive heart failure. Her troponin levels were normal and her creatinine on routine examination was 7.5 mg/dL. She was admitted to the hospital and an emergent kidney biopsy was requested. Figure 1 shows a normal glomerulus. Figure 2 shows no significant interstitial fibrosis. Figure 3 shows severe arteriosclerosis. Figure 4...

Diagnose This (October 29, 2018)

What class of disease does this patient have and how did they present clinically?           ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​...

Focal Segmental Glomerulosclerosis (FSGS), Tip Variant

This biopsy was performed on a 9-year-old female with no significant past medical history, who presents with nephrotic syndrome. The serum creatinine at the time of the biopsy was 0.7 mg/dl. The UPCR was 9.6 g/g. Serum albumin was 2.1 g/dl. Complement levels and ANA were normal/negative. The biopsy shows glomeruli with minimal mesangial matrix expansion and hypercellularity (Fig 1), in the absence of segmental glomerulosclerosis or proliferative lesions. Immunofluorescence was negative for IgA, IgG, IgM, C3, C1q and kappa and lambda light chains (not shown). Electron microscopy shows widespread blunting, widening and effacement of epithelial foot processes (Fig 2),...

Minimal Change Disease and Acute Kidney Injury

This 81-year-old male with past medical history of hypertension and coronary artery disease presents with acute kidney injury (Cr = 4.6 mg/dl). A renal biopsy was performed and shows acute tubular injury characterized by markedly vacuolated and reactive tubular epithelium with loss of the proximal tubular brush border (Fig 1). The glomeruli are completely unremarkable by light microscopy (Fig 2) and there is no evidence of immune complex deposition by immunofluorescence. However, electron microscopy shows diffuse epithelial foot process effacement with microvillous transformation (Fig 3). The morphologic findings are consistent with minimal change disease. After further review of the medical...

Minimal Change Disease and New Onset DM type I

AN ODD COINCIDENCE? OR ARE THEY RELATED? This biopsy is from a teenager who had a viral illness 6 weeks ago. Five weeks ago, he developed polyphagia and polydipsia and was found to have new onset Type I Diabetes Mellitus. One week prior to renal biopsy, he had the sudden onset of facial edema and a urine protein/creatinine ratio of 7.8. Image 1. No change by light microscopy. Image 2. Diffuse and complete foot process effacement. Diagnosis: Minimal Change Disease Simultaneous occurrence of Type 1 Diabetes and Minimal Change Disease has been reported. Here is a link to a case...