CRP-02 - Revision history

Peter Anderson at 14:22, 8 October 2026

2026-10-08T14:22:00Z

← Older revision		Revision as of 09:22, 8 October 2026
Line 9:		Line 9:

	==Pathology==		==Pathology==
	===Slide #CRP-002 HE===		===Slide CRP-002 HE===
	<peir-vm>specialcrp/CRP-002_HE</peir-vm>		<peir-vm>specialcrp/CRP-002_HE</peir-vm>
	===Slide #CRP-002 PASH===		===Slide CRP-002 PASH===
	<peir-vm>specialcrp/CRP-002_PASH</peir-vm>		<peir-vm>specialcrp/CRP-002_PASH</peir-vm>
	===Slide #CRP-002 silver===		===Slide CRP-002 silver===
	<peir-vm>specialcrp/CRP-002_silver</peir-vm>		<peir-vm>specialcrp/CRP-002_silver</peir-vm>

	<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer"> Microscopic Description, Immunofluorescence, and Electron Microscopy.</div>		<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer"> Microscopic Description, Immunofluorescence, and Electron Microscopy</div>
	<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis">		<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis">
	<div class="mw-collapsible-content">		<div class="mw-collapsible-content">

	==Microscopic Description==		==Microscopic Description==
	===Light ~~Mcrscopy~~===		===Light Microscopy===
	The specimen consists of a fragment of renal cortex that contains at least 16 glomeruli. Four of these are obsolete. However, all four of the obsolete glomeruli are at one end of the specimen in an area of moderately dense fibrosis and marked tubular dropout. This probably represents a focal scar. The remaining glomeruli are all similar and show mild segmental mesangial cell proliferation. Capillary loops are widely patent, and the silver and PASH stains show marked thickening of the capillary basement membranes. The silver stain also demonstrates well developed spikes along all of the epithelial surfaces. There are no areas of segmental sclerosis or necrosis. No crescents are present. There is mild interstitial edema, but interstitial fibrosis is minimal except in the single small focus of scarring. There is no significant tubular atrophy. No inflammatory infiltrates are present. A number of vessels are present in the biopsy, and they are all unremarkable.		The specimen consists of a fragment of renal cortex that contains at least 16 glomeruli. Four of these are obsolete. However, all four of the obsolete glomeruli are at one end of the specimen in an area of moderately dense fibrosis and marked tubular dropout. This probably represents a focal scar. The remaining glomeruli are all similar and show mild segmental mesangial cell proliferation. Capillary loops are widely patent, and the silver and PASH stains show marked thickening of the capillary basement membranes. The silver stain also demonstrates well developed spikes along all of the epithelial surfaces. There are no areas of segmental sclerosis or necrosis. No crescents are present. There is mild interstitial edema, but interstitial fibrosis is minimal except in the single small focus of scarring. There is no significant tubular atrophy. No inflammatory infiltrates are present. A number of vessels are present in the biopsy, and they are all unremarkable.

Peter Anderson at 20:30, 7 October 2026

2026-10-07T20:30:48Z

← Older revision		Revision as of 15:30, 7 October 2026
Line 5:		Line 5:
	BUN 22, creatinine 0.8, Creatinine clearance 130 ml/min, urinary protein 11 .8 g/24 hr. BP 152/102.		BUN 22, creatinine 0.8, Creatinine clearance 130 ml/min, urinary protein 11 .8 g/24 hr. BP 152/102.

	==Gross Description:==		==Gross Description==
	Received in transport media is one core of renal tissue measuring 7.5 mm in length. This core is bisected, and a 1-mm fragment is taken from each end and submitted for EM. One half of the remaining core is submitted for immunofluorescence, and the other half is submitted for light microscopy.		Received in transport media is one core of renal tissue measuring 7.5 mm in length. This core is bisected, and a 1-mm fragment is taken from each end and submitted for EM. One half of the remaining core is submitted for immunofluorescence, and the other half is submitted for light microscopy.

Line 20:		Line 20:
	<div class="mw-collapsible-content">		<div class="mw-collapsible-content">

	==Microscopic Description:==		==Microscopic Description==
	===Light Mcrscopy:===		===Light Mcrscopy===
	The specimen consists of a fragment of renal cortex that contains at least 16 glomeruli. Four of these are obsolete. However, all four of the obsolete glomeruli are at one end of the specimen in an area of moderately dense fibrosis and marked tubular dropout. This probably represents a focal scar. The remaining glomeruli are all similar and show mild segmental mesangial cell proliferation. Capillary loops are widely patent, and the silver and PASH stains show marked thickening of the capillary basement membranes. The silver stain also demonstrates well developed spikes along all of the epithelial surfaces. There are no areas of segmental sclerosis or necrosis. No crescents are present. There is mild interstitial edema, but interstitial fibrosis is minimal except in the single small focus of scarring. There is no significant tubular atrophy. No inflammatory infiltrates are present. A number of vessels are present in the biopsy, and they are all unremarkable.		The specimen consists of a fragment of renal cortex that contains at least 16 glomeruli. Four of these are obsolete. However, all four of the obsolete glomeruli are at one end of the specimen in an area of moderately dense fibrosis and marked tubular dropout. This probably represents a focal scar. The remaining glomeruli are all similar and show mild segmental mesangial cell proliferation. Capillary loops are widely patent, and the silver and PASH stains show marked thickening of the capillary basement membranes. The silver stain also demonstrates well developed spikes along all of the epithelial surfaces. There are no areas of segmental sclerosis or necrosis. No crescents are present. There is mild interstitial edema, but interstitial fibrosis is minimal except in the single small focus of scarring. There is no significant tubular atrophy. No inflammatory infiltrates are present. A number of vessels are present in the biopsy, and they are all unremarkable.

	===Immunofluorescence:===		===Immunofluorescence===
	There are eight glomeruli in the sections. None show segmental sclerosis. There is diffuse granular staining along capillary loops that is graded 4+ for IgG and kappa light chain, 3+ for lambda light chain, l+ for C3, and trace for IgA and Clq. There is no staining for IgM. There is l+ staining in mesangial regions for these same reagents. Tubular epithelium stains 4+ for albumin. There is no staining of the vessels.		There are eight glomeruli in the sections. None show segmental sclerosis. There is diffuse granular staining along capillary loops that is graded 4+ for IgG and kappa light chain, 3+ for lambda light chain, l+ for C3, and trace for IgA and Clq. There is no staining for IgM. There is l+ staining in mesangial regions for these same reagents. Tubular epithelium stains 4+ for albumin. There is no staining of the vessels.

	===Electron Microscopy:===		===Electron Microscopy===
	Two thick sections containing a total of seven glomeruli are available. These are similar to those described under Light Microscopy. Ultrastructural examination reveals numerous intramembranous and occasional subepithelial electron-dense deposits. No deposits are identified in subendothelial locations. Capillary basement membranes are diffusely thickened, and there is complete effacement of the visceral cell foot processes. Mesangial areas are expanded and contain numerous small electron-dense deposits.		Two thick sections containing a total of seven glomeruli are available. These are similar to those described under Light Microscopy. Ultrastructural examination reveals numerous intramembranous and occasional subepithelial electron-dense deposits. No deposits are identified in subendothelial locations. Capillary basement membranes are diffusely thickened, and there is complete effacement of the visceral cell foot processes. Mesangial areas are expanded and contain numerous small electron-dense deposits.
	These histologic features are those of membranous glomerulonephritis. The presence of mesangial deposits in addition to the usual subepithelial deposits is often seen in cases of membranous glomerulonephritis associated with systemic diseases, especially SLE and hepatitis B. Idiopathic membranous nephropathy seldom has mesangial deposits. Furthermore, although it was not very impressive, there was definite weakly positive immunofluorescence for Clq and IgA, which is distinctly unusual in idiopathic membranous nephropathy and more suggestive of lupus nephritis. Clinical follow-up is suggested to rule out other systemic processes.		These histologic features are those of membranous glomerulonephritis. The presence of mesangial deposits in addition to the usual subepithelial deposits is often seen in cases of membranous glomerulonephritis associated with systemic diseases, especially SLE and hepatitis B. Idiopathic membranous nephropathy seldom has mesangial deposits. Furthermore, although it was not very impressive, there was definite weakly positive immunofluorescence for Clq and IgA, which is distinctly unusual in idiopathic membranous nephropathy and more suggestive of lupus nephritis. Clinical follow-up is suggested to rule out other systemic processes.

Peter Anderson at 15:03, 7 October 2026

2026-10-07T15:03:28Z

← Older revision		Revision as of 10:03, 7 October 2026
Line 1:		Line 1:
	'''CRP-02'''		'''CRP-02'''
	== Clinical History==		== Clinical History==
	The patient is a 76 year old ~~female~~.		The patient is a 46 year old male.

	~~Recently detected renal insufficiency, proteinuria and hypertension.~~ BUN 50, creatinine 2.6, ~~creatinine~~ clearance 36 ml/min, urinary protein 3.5 g/24 hr. BP ~~150~~/90.		BUN 22, creatinine 0.8, Creatinine clearance 130 ml/min, urinary protein 11 .8 g/24 hr. BP 152/102.

	==Gross Description:==		==Gross Description:==
	Received in ~~Zeus fixative~~ is one core of renal tissue measuring 1.~~1 cm~~ in length. This is ~~entirely submitted for immunofluorescence. Received in Carson's fixative are two cores of tissue measuring 8 mm each. Two~~ 1-mm ~~fragments are~~ taken for EM, and the ~~remaining tissue~~ is ~~processed~~ for light microscopy.		Received in transport media is one core of renal tissue measuring 7.5 mm in length. This core is bisected, and a 1-mm fragment is taken from each end and submitted for EM. One half of the remaining core is submitted for immunofluorescence, and the other half is submitted for light microscopy.

	==Pathology==		==Pathology==
Line 21:		Line 21:

	==Microscopic Description:==		==Microscopic Description:==
	===~~LIGHT MICROSCOPY~~:===		===Light Mcrscopy:===
	The specimen consists of ~~two fragments~~ of renal cortex that ~~contain~~ at least 36 glomeruli. Four of these are obsolete. The remaining glomeruli are all similar and show ~~striking diffuse~~ proliferation ~~with accentuation of the normal lobular pattern~~. ~~Many of the extra cells in the glomeruli are polymorphonuclear leukocytes. Because of the marked mesangial and endocapillary proliferation, Very few capillary~~ loops are ~~still~~ patent~~. Silver~~ and PASH stains show thickening of the capillary basement membranes~~, and examples of double contours consistent with mesangial interposition are identified with the silver stain~~. The ~~trichrome~~ stain ~~shows reddish-orange subendothelial deposits in some~~ of the ~~loops, which probably represent immune complex deposits~~. No segmental sclerosis or necrosis ~~is identified, and there~~ are ~~no epithelial crescents~~. There is ~~diffuse~~ mild interstitial fibrosis~~, and there~~ is ~~focal mild~~ tubular atrophy. ~~However, many of the tubules still show very good preservation~~. ~~Occasional lymphocytes and plasma cells are scattered throughout the interstitium, but no large collections~~ of ~~inflammatory cells~~ are present~~. There is no tubulitis. The small arteries~~ in the biopsy ~~show minimal intimal fibrosis~~, and ~~there is no evidence of vasculitis~~.		The specimen consists of a fragment of renal cortex that contains at least 16 glomeruli. Four of these are obsolete. However, all four of the obsolete glomeruli are at one end of the specimen in an area of moderately dense fibrosis and marked tubular dropout. This probably represents a focal scar. The remaining glomeruli are all similar and show mild segmental mesangial cell proliferation. Capillary loops are widely patent, and the silver and PASH stains show marked thickening of the capillary basement membranes. The silver stain also demonstrates well developed spikes along all of the epithelial surfaces. There are no areas of segmental sclerosis or necrosis. No crescents are present. There is mild interstitial edema, but interstitial fibrosis is minimal except in the single small focus of scarring. There is no significant tubular atrophy. No inflammatory infiltrates are present. A number of vessels are present in the biopsy, and they are all unremarkable.

	===Immunofluorescence:===		===Immunofluorescence:===
	There are ~~sixteen~~ glomeruli in the sections. None ~~contain epithelial crescents or foci of~~ segmental sclerosis. There is diffuse~~, coarse,~~ granular staining along ~~the~~ capillary loops that is graded 4+ for C3, 2+ for ~~IgG and~~ light ~~chains~~, ~~and~~ l+ for IgA. There is ~~also focal and segmental l+~~ staining ~~of the capillary loops~~ for ~~Clq~~. There is staining ~~of similar intensity~~ in ~~the~~ mesangial regions for ~~all of~~ these reagents~~. There is no staining in the glomeruli for IgM~~. Tubular epithelium ~~contains occasional~~ albumin ~~droplets~~. There is no staining of the ~~tubular basement membranes~~. ~~There is no staining of the vessels~~		There are eight glomeruli in the sections. None show segmental sclerosis. There is diffuse granular staining along capillary loops that is graded 4+ for IgG and kappa light chain, 3+ for lambda light chain, l+ for C3, and trace for IgA and Clq. There is no staining for IgM. There is l+ staining in mesangial regions for these same reagents. Tubular epithelium stains 4+ for albumin. There is no staining of the vessels.

	===Electron Microscopy:===		===Electron Microscopy:===
	Two thick sections are available. ~~One contains two glomeruli, but the other contains only a portion of a glomerulus on one edge.~~ These are similar to those described under ~~light microscopy~~ and ~~show striking diffuse hypercellularity with compromise of the capillary lumina~~. ~~Many of the capillary lumina~~ are ~~completely ·filled with polymorphonuclear leukocytes~~. Capillary basement membranes are ~~generally of normal thickness~~, ~~but~~ there is ~~focal thickening with mesangial cell interposition. There is diffuse~~ effacement of the visceral ~~epithelial~~ foot processes. ~~Numerous subendothelial electron dense deposits~~ are ~~identified,~~ and ~~occasional~~ small ~~mesangial~~ electron dense deposits ~~are also noted~~. ~~Subepithelial deposits~~ are ~~easily identified, and some are extremely large ("humps").~~		Two thick sections containing a total of seven glomeruli are available. These are similar to those described under Light Microscopy. Ultrastructural examination reveals numerous intramembranous and occasional subepithelial electron-dense deposits. No deposits are identified in subendothelial locations. Capillary basement membranes are diffusely thickened, and there is complete effacement of the visceral cell foot processes. Mesangial areas are expanded and contain numerous small electron-dense deposits.
			These histologic features are those of membranous glomerulonephritis. The presence of mesangial deposits in addition to the usual subepithelial deposits is often seen in cases of membranous glomerulonephritis associated with systemic diseases, especially SLE and hepatitis B. Idiopathic membranous nephropathy seldom has mesangial deposits. Furthermore, although it was not very impressive, there was definite weakly positive immunofluorescence for Clq and IgA, which is distinctly unusual in idiopathic membranous nephropathy and more suggestive of lupus nephritis. Clinical follow-up is suggested to rule out other systemic processes.
	~~This pattern~~ of ~~diffuse proliferative~~ glomerulonephritis ~~is not specific and may occur in association with a number of systemic diseases, including autoimmune diseases, infections, and chronic liver disease~~. The presence of ~~so many neutrophils~~ in ~~conjunction with large~~ subepithelial deposits is ~~most consistent with acute postinfectious glomerulonephritis. Although acute postinfectious~~ glomerulonephritis ~~is most typically~~ associated with ~~streptococcal infections~~, ~~the MPGN-like features of the lesion (focal~~ mesangial ~~interposition, subendothelial~~ deposits~~) suggests a chronic infection~~. ~~The most common chronic infections associated with this type of glomerulonephritis include hepatitis B or C~~, ~~visceral abscess~~, and ~~mycoplasma~~.
	</div></div>		</div></div>

	<spoiler text="Diagnosis and Comments">		<spoiler text="Diagnosis and Comments">
	Kidney, needle ~~biopsy · Diffuse proliferative glomerulonephritis~~, ~~consistent with acute postinfectious glomerulonephritis (see description)~~.		Kidney, needle biopsy· Membranous nephropathy, Stage III.

	~~T71000 KIDNEY, P11430 BIOPSY, NEEDLE, M46812 GLOMERULONEPHRJTIS, PROLIFERATIVE, DIFFUSE~~
	~~M40000 GLOMERULONEPHRITIS, T71200 GLOMERULUS~~
	</spoiler>		</spoiler>

Peter Anderson: /* CRP-02 */

2026-10-07T14:48:37Z

CRP-02

← Older revision		Revision as of 09:48, 7 October 2026
Line 1:		Line 1:
	== [[CRP-~~02\|~~CRP-~~02]]~~ ==		'''CRP-02'''
			== Clinical History==
			The patient is a 76 year old female.

			Recently detected renal insufficiency, proteinuria and hypertension. BUN 50, creatinine 2.6, creatinine clearance 36 ml/min, urinary protein 3.5 g/24 hr. BP 150/90.

			==Gross Description:==
			Received in Zeus fixative is one core of renal tissue measuring 1.1 cm in length. This is entirely submitted for immunofluorescence. Received in Carson's fixative are two cores of tissue measuring 8 mm each. Two 1-mm fragments are taken for EM, and the remaining tissue is processed for light microscopy.

			==Pathology==
			===Slide #CRP-002 HE===
			<peir-vm>specialcrp/CRP-002_HE</peir-vm>
			===Slide #CRP-002 PASH===
			<peir-vm>specialcrp/CRP-002_PASH</peir-vm>
			===Slide #CRP-002 silver===
			<peir-vm>specialcrp/CRP-002_silver</peir-vm>

			<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer"> Microscopic Description, Immunofluorescence, and Electron Microscopy.</div>
			<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis">
			<div class="mw-collapsible-content">

			==Microscopic Description:==
			===LIGHT MICROSCOPY:===
			The specimen consists of two fragments of renal cortex that contain at least 36 glomeruli. Four of these are obsolete. The remaining glomeruli are all similar and show striking diffuse proliferation with accentuation of the normal lobular pattern. Many of the extra cells in the glomeruli are polymorphonuclear leukocytes. Because of the marked mesangial and endocapillary proliferation, Very few capillary loops are still patent. Silver and PASH stains show thickening of the capillary basement membranes, and examples of double contours consistent with mesangial interposition are identified with the silver stain. The trichrome stain shows reddish-orange subendothelial deposits in some of the loops, which probably represent immune complex deposits. No segmental sclerosis or necrosis is identified, and there are no epithelial crescents. There is diffuse mild interstitial fibrosis, and there is focal mild tubular atrophy. However, many of the tubules still show very good preservation. Occasional lymphocytes and plasma cells are scattered throughout the interstitium, but no large collections of inflammatory cells are present. There is no tubulitis. The small arteries in the biopsy show minimal intimal fibrosis, and there is no evidence of vasculitis.

			===Immunofluorescence:===
			There are sixteen glomeruli in the sections. None contain epithelial crescents or foci of segmental sclerosis. There is diffuse, coarse, granular staining along the capillary loops that is graded 4+ for C3, 2+ for IgG and light chains, and l+ for IgA. There is also focal and segmental l+ staining of the capillary loops for Clq. There is staining of similar intensity in the mesangial regions for all of these reagents. There is no staining in the glomeruli for IgM. Tubular epithelium contains occasional albumin droplets. There is no staining of the tubular basement membranes. There is no staining of the vessels

			===Electron Microscopy:===
			Two thick sections are available. One contains two glomeruli, but the other contains only a portion of a glomerulus on one edge. These are similar to those described under light microscopy and show striking diffuse hypercellularity with compromise of the capillary lumina. Many of the capillary lumina are completely ·filled with polymorphonuclear leukocytes. Capillary basement membranes are generally of normal thickness, but there is focal thickening with mesangial cell interposition. There is diffuse effacement of the visceral epithelial foot processes. Numerous subendothelial electron dense deposits are identified, and occasional small mesangial electron dense deposits are also noted. Subepithelial deposits are easily identified, and some are extremely large ("humps").

			This pattern of diffuse proliferative glomerulonephritis is not specific and may occur in association with a number of systemic diseases, including autoimmune diseases, infections, and chronic liver disease. The presence of so many neutrophils in conjunction with large subepithelial deposits is most consistent with acute postinfectious glomerulonephritis. Although acute postinfectious glomerulonephritis is most typically associated with streptococcal infections, the MPGN-like features of the lesion (focal mesangial interposition, subendothelial deposits) suggests a chronic infection. The most common chronic infections associated with this type of glomerulonephritis include hepatitis B or C, visceral abscess, and mycoplasma.
			</div></div>

			<spoiler text="Diagnosis and Comments">
			Kidney, needle biopsy · Diffuse proliferative glomerulonephritis, consistent with acute postinfectious glomerulonephritis (see description).

			T71000 KIDNEY, P11430 BIOPSY, NEEDLE, M46812 GLOMERULONEPHRJTIS, PROLIFERATIVE, DIFFUSE
			M40000 GLOMERULONEPHRITIS, T71200 GLOMERULUS
			</spoiler>

Peter Anderson: Created page with "== CRP-02 =="

2026-10-07T14:36:54Z

Created page with "== CRP-02 =="

New page

== [[CRP-02|CRP-02]] ==