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Currently filtering by tag: Thrombotic microangiopathy

Art of Medicine: Thrombotic Microangiopathy

Thrombotic Microangiopathy
The above painting shows a glomerulus containing capillary loop fibrin thrombi, an arteriole with onion-skinning, and acute tubular injury, findings that can be seen in thrombotic microangiopathy.  Morphologic findings of thrombotic microangiopathy that can be seen on a renal biopsy include arteriolar or capillary loop fibrin or platelet thrombi, red blood cell fragmentation within glomerular capillary loops or within arteries, mesangiolysis, endothelial cell swelling,  glomerular basement membrane duplication, mucoid intimal edema of arteries, and a myointimal proliferation surrounding arterioles (onion-skinning like reaction). Thrombotic microangiopathy (TMA) has a wide clinical differential diagnosis, which can have substantial morphologic overlap on a kidney...

Disease Week: Onco-Nephrology

Monday Onco-nephrology is a rapidly developing area of nephrology designed to help address and prevent kidney problems and the many complex issues that arise in cancer patients. AKI is a common complication in cancer patients. The highest 1-year risk of AKI was seen in patients with kidney cancer (44%), liver cancer (33%), and multiple myeloma (31.8%) in one large population-based cohort study. Patients with distant metastases were at highest risk. https://www.ncbi.nlm.nih.gov/pubmed/21767759 What is the most common glomerular pathology reported in patients with solid tumors? Minimal change disease Membranoproliferative glomerulonephritis Membranous nephropathy Thrombotic microangiopathy   Answer: Membranous nephropathy.  The incidence of cancer was significantly higher in patients with...

Diagnose This (August 5, 2019)

What is this finding in this native kidney?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​...

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 (April 8, 2019)

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

Diagnose This (August 27, 2018)

What is this finding and what is the likely etiology?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​    ...

Endocapillary Hypercellularity in Thrombotic Microangiopathy

This renal biopsy performed on a 14-year-old boy shows changes diagnostic of a thrombotic microangiopathy (TMA). These changes include frequent fibrin thrombi within the arteriolar lumens and glomerular hilum, endothelial swelling, mesangiolysis and focal glomerular ischemic changes (Fig 1-3). Of note, the glomeruli frequently show marked global endocapillary hypercellularity, mostly composed of swollen endothelial cells and occasional circulating inflammatory cells (Fig 4). Immunofluorescence and electron microscopy show absence of immune complex deposition (not shown). This case illustrates that a subset of cases of TMA may show endocapillary hypercellularity and is important to avoid misdiagnosing such cases as a proliferative glomerulonephritis....