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Currently filtering by tag: Proliferative glomerulonephritis

Art of Medicine: Proliferative Glomerulonephritis

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...

Infection-Associated Glomerulonephritis

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...

Infection-Associated Glomerulonephritis

Infection-Associated Glomerulonephritis in renal biopsy
This biopsy is taken from a 39-year-old woman who presents with abdominal pain, ascites, and lower extremity edema. Her serum creatinine is 3.9 mg/dL and her complete blood count shows leukocytosis (14,500). Initial serologic workup is negative. The biopsy shows a diffuse proliferative glomerulonephritis characterized by global endocapillary hypercellularity with prominent neutrophils, best visualized using methenamine silver staining (Fig. 1). No crescents, necrotizing lesions, or significant double contours are identified. By immunofluorescence, there is coarsely granular (3+) capillary wall and less prominent mesangial staining for IgG, C3, kappa, and lambda (Fig. 2). Electron microscopy shows global endocapillary proliferation and numerous...

Diagnose This (April 2, 2018)

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

When Lightning Strikes Twice

AL amyloidosis, ANCA, digging deeper, Dr. Messias, Arkana Laboratories, pathology diseases
This biopsy came to us for a workup on proteinuria.  The patient is a 68-year-old female with a history of “low-grade non-Hodgkin’s lymphoma” initially diagnosed in 2007. She was treated with rituximab, from November 2007 to July 2009.  She was treated with Treanda (bendamustine ) during the spring of 2010.  In 2010, she presented with proteinuria and a renal biopsy established the diagnosis of membranoproliferative glomerulonephritis (MPGN).  Her symptoms resolved with chemotherapy and lymphoma treatment and remission.  She now presents once again with proteinuria. The patient is in remission from the lymphoma. A renal biopsy was performed to establish the cause...

Pushing Glass (March 13, 2018)

intravascular diffuse large B-cell lymphoma, arkana laboratories, pushing glass, renal pathology
A 65-year-old male presents with mild proteinuria and a sudden increase in creatinine. He was recently diagnosed with widely metastatic gastric carcinoma and has received 4 rounds of chemotherapy. During treatment with chemotherapy, his creatinine increased to 3.5 and has remained at that level despite fluid resuscitation. A kidney biopsy is performed. What is the best diagnosis? A. Membranoproliferative Glomerulonephritis B. Metastatic Gastric Carcinoma C. Intravascular Diffuse Large B-Cell Lymphoma D. Thrombotic Microangiopathy The best answer is C – Intravascular Diffuse Large B-Cell Lymphoma This is a very difficult case due to the proliferative nature of the glomeruli. At first...

Membranoproliferative Glomerulonephritis Pattern

This glomerulus shows a membranoproliferative glomerulonephritis (MPGN) pattern of injury. To a large extent, the etiologic differential diagnosis depends on the immunofluorescence and ultrastructural findings. This light microscopic pattern of injury may be seen in one of the so-called C3 glomerulopathies, in MPGN with immune complexes (no known clinical cause), or in so-called "secondary" forms of MPGN in patients who have underlying infection, autoimmune disease, or dysproteinemia. Identifying the pattern of injury is only the beginning of the workup in many cases!

Infection-Associated GN

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...