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Currently filtering by tag: Myoglobin

ATI With Pigmented Casts

This biopsy is a 54-year-old female without significant past medical history, who presented with acute kidney injury. The serum creatinine at presentation was 7.2 mg/dl. Light microscopy shows diffuse acute tubular injury characterized by marked attenuation of the tubular epithelium with loss of the proximal tubular brush borders (not shown). Additionally, the tubular lumens frequently show globular, retractile, brightly eosinophilic and fuchsinophilic casts, without an associated cellular reaction (Fig 1, PAS; Fig 2, Trichrome). The differential diagnosis of acute tubular injury with pigmented casts includes hemoglobin cast nephropathy, myoglobin cast nephropathy, bile cast nephropathy, light chain cast nephropathy and acute...

Diagnose This! (July 24, 2017)

What is your diagnosis?       ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​  ...

Myoglobin Casts

A 54-year-old man with a history of hypertension and hypercholesterolemia presented with complaints of generalized “muscle stiffness” and cola-colored urine. He was found to have markedly elevated serum creatinine and creatine kinase levels. A renal biopsy showed acute tubular injury with numerous pigmented casts (Fig 1), which were proven to be myoglobin casts by immunohistochemistry (Fig 2). The etiology of the patient’s myoglobinuria was thought to be statin medication, the dose of which had recently been increased. Here is a link to a recent article describing the morphologic spectrum of myoglobin casts in renal biopsies:https://www.ncbi.nlm.nih.gov/pubmed/?term=27038680.