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Tuesday slide seminar, September 4th, 2007
Heikki Helin – Renal Pathology
Division of Pathology, HUSLAB, University Central Hospital, Helsinki, Finland
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Case 1
1,5-year-old boy with peripheral oedema for one month. On admission to hospital proteinuria of nephrotic level, microscopic hematuria, normal serum creatinin and normal diuresis were observed. Steroid therapy was started, without response. Hematuria increased up to 30 RBC/eyefield. ANA, ANCA, GBM-Ab, C3 normal, C4 marginally low, no evidence of streptococcal infection. Percutaneous renal biopsy specimen was not adequate. Therefore a surgical wedge biopsy was taken. Immunofluorescence staining showed diffuse, granular, mesangial staining for IgM (++), C1q (++), IgG (+) and C3 (+) in glomeruli.
PAS/Hx staining
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Diagnosis & discussion |
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Case 2
Female, 76 years. 2-3 years ago heavy proteinuria in a single urinary specimen. Also examined for microscopic hematuria, results not known. Renal studies started now because of renal insufficiency (creatinin clearance decreased to half of normal), nephrotic syndrome and anemia.
Slide a) PAS-Hx;
Slide b) Jones´silver methenamine
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Diagnosis & discussion |
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Case 3
71-year old male with acute or subacute renal failure, anemia, elevated ESR. Serum creatinin 600 µmol/l, mild proteinuria and hematuria.
Masson´s trichrome
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Diagnosis & discussion |
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Case 4
46-year-old male with a history of surgically treated prostate cancer was admitted to hospital because of mild renal insufficiency (serum creatinin increased form 86 to 136 µmol/l within one year). No signs of obstruction were observed. dU-prot was 0.7g with a marked proportion of tubular protein, no paraproteins, ESR and CRP normal. Within 6 weeks the creatinin level increased to 500 µmol/l and a renal biopsy was performed for suspected interstitial nephritis.
Masson´s trichrome
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Diagnosis & discussion |
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Case 5
74-year-old female with hypertension, hyperlipidemia, hypothyroidism and asthma. Frequent use of analgesics for chronic lower back pain. S-Crea has increased during a couple of years being now 250 µmol/l. Renal arteries radiologically normal. Tubular proteinuria.
Slide a) PAS-Hx;
Slide b) Masson´s trichrome
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Diagnosis & discussion |
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Slide 6a |
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Slide 6b |
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Slide 6c |
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Case 6
Female of 67 years with nephrotic syndrome. Serum creatinin is 300 µmol/l and electrophoresis shows a possible minor paraprotein. Amyloidosis is suspected.
Slide a) H&E;
Slide b) Kongo red;
Slide c) immunogold labeling for lambda light chains
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Diagnosis & discussion |
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