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Currently filtering by tag: Thrombotic microangiopathy

Disease Week: Onco-Nephrology

The rapidly evolving field of oncology and cancer management creates unique opportunities as well as challenges for the nephrology community.  As such, it is important for nephrologists and nephropathologists to be informed and involved in its many aspects in order to better care for patients and be valuable members of a multidisciplinary cancer care team.  The renal manifestations and complications of cancer are myriad and include acute as well as chronic kidney injury, electrolyte/acid–base disturbances, direct injury of the kidney through tumor infiltration and/or paraneoplastic substances, pharmacokinetics of chemotherapeutic agents, and hematopoietic cell transplantation-related kidney injury.  Kidney transplant patients also...

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....

Anti-VEGF Effect

This biopsy was taken from an older adult man with acute kidney injury and non-nephrotic range proteinuria.  His medical history included metastatic colonic adenocarcinoma, for which he was taking bevacizumab, an anti-vascular endothelial growth factor (anti-VEGF) inhibitor.  The sampled glomeruli show changes of thrombotic microangiopathy (TMA), including double contour formation of glomerular capillaries (Fig. 1) and intracapillary red blood cell fragmentation (Fig. 2).  TMA is one of the most common adverse effects in the kidney of bevacizumab therapy, and it has been reported as early as one week after starting the drug.  Other pathologies reported in the setting of anti-VEGF...