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RENAL BIOPSY SLIDE SEMINAR March 17th, 2009
Department of Pathology
Tampere University Hospital
Heikki Helin
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Case 1a |
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Case 1b |
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Case 1 EM |
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Case 1
Female, 35 years.
Carrier of Fabry’s disease. Marginal albuminuria, otherwise no signs or symptoms of renal disease. Renal biopsy performed on neurologists request.
Immunofluorescence: Bright mesangial, granular IgA deposits, less intensive IgM and C3 with similar pattern and location.
Electron micrograph: Glomerular podocyte with large electron-dense myelin figures.
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Diagnosis & discussion |
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Case 2
Male, 69 years.
Years ago amputation of toes because of vasculitis-like disease. Centromere-antibodies positive, some fragmentation hemolysis. Now acute renal insufficience and thrombocytopenia. Thrombotic microan-giopathy or acute tubular necrosis suspected.
Immunofluorescence: Very scanty glomerular, segmental IgM.
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Diagnosis & discussion |
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Case 3
Female, 61 years.
Previously healthy female with oliguric renal failure. 15% plasma cells in bone marrow. High ESR, free IgG-lambda light chains in serum. Renal biopsy with following questions: myeloma cast nephropathy, multiple myeloma-associated AL-amyloidosis or light chain deposition disease?
Immunofluorescence: Brightly fluorescent lambda light chain casts in tubular lumina.
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Diagnosis & discussion |
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Case 4
Female, 64 years.
Hypertesion, type 2 diabetes mellitus. GBM-antibodies and ANCA negative, nuclear antibodies positive. Proteinuria (urinary albumin 2-3+), no hematuria. Serum creatinine 435-500 ?mol/l. Renal biopsy for rapidly developed renal failure.
Immunofluorescence: No glomeruli, no findings in tubulointerstitial tissue or vessels.
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Diagnosis & discussion |
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Case 5
Female, 69 years.
Hypertensive female with acute to subacute uremia of unknown etiology. Serum creatinine 2000 ?mol/l. Mild proteinuria and microscopic hematuria. GBM antibodies and ANCA negative. Patient at least to some extent dehydrated.
Immunofluorescence: No glomeruli, no findings in tubulointerstitial tissue or vessels.
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Diagnosis & discussion |
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Case 6
Male, 46 years.
Proteinuria observed 10 years earlier, no further evaluation. Six months ago diagnosis of DM type 2. Serum creatinine normal. Proteinuria of 3.38 g/24h, no hematuria.
Immunofluorescence: Focal and segmental, granular, mesangial IgM.
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Diagnosis & discussion |
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Case 7
Female, 25 years.
Three years earlier acute extracapillary glomerulonephritis. Now CRP somewhat increased, mild pro-teinuria and microscopic hematuria. P-ANCA +, MPO titre high. Serum creatinine is normal and the patient is symptome free. Renal biopsy is performed to detect any active renal vasculitis.
Immunofluorescence: Very scanty, granular, mesangial deposits of IgM (‘pauci-immune’).
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Diagnosis & discussion |
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Case 8
Male, 42 years.
Chronic pancreatitis and DM. Proteinuria of 0,19 g/24h. Serum creatinine 457 ?mol/l. Compression fracture of L1 without verified trauma. Acute renal failure with suspected myeloma cast nephropathy.
Bone marrow aspirate taken but not yet reported. Renal biopsy performed.
Immunofluorescence: Very little mesangial IgM in granular pattern.
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Diagnosis & discussion |
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Case 9
Female, 26 years.
SLE since the age of 6 years. Diffuse proliferative glomerulonephritis diagnosed in childhood. AIHA, phospholipid syndrome, blindness due to retinitis. Serum creatinine 63 ?mol/l, dU-prot 2.7 g, urinary RBC 7/HPF. Renal biopsy for nephritic syndrome: morphologic evidence of active lupus nephritis?
Immunofluorescence: Diffuse, granular, capillary IgG (++), IgA (++), IgM (++), C3 (++) and C1q (+++).
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Diagnosis & discussion |
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Case 10
Male, 44 years.
Renal transplantation for IgA glomerulonephritis 6 years ago. 2 years post transplantation acute cellular rejection G 2A, IF negative. At present, immunosuppressive treatment tacrolimus and MMF, low dose steroid stopped a few months ago. At the time of renal biopsy microhematuria, marginal proteinuria and slowly increasing serum cretinine (now 174 ?mol/l). Recurrence of original renal disease?
Immunofluorescence: Diffuse, global, granular, mesangial IgA (++) and C3 (+/++).
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Diagnosis & discussion |
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