CRP-51: Difference between revisions - Pathology Education Instructional Resource

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'''CRP-51'''

==Clinical History==

The patient is a 43 year old white woman with acute onset of a renal and hepatic disease 3-4 months prior to admission. Creatinine - 2.0; creatinine clearance - 57 cc/min; 24 hour protein - 0.7 grams. Serologies include normal C3/C4; negative ASO; negative SPEP; negative ANCAs. The renal ultrasound is normal.

==Gross Description:==

==Gross Description==

Received in Carson's fixative is a single needle core that measures 15.0 x 1.0 mm. Two 1.0 mm pieces are separated for ultrastructural studies and the remainder is processed for light microscopy. An additional two cores that measure 10.0 and 11.0 mm in length and 1.0 mm each in diameter are received in Zeus fixative and are processed for immunofluorescence microscopy.

==Pathology==

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==Microscopic Description:==

==Microscopic Description==

===Light Microscopy:===

===Light Microscopy===

Sections are of two needle cores of renal cortex, one of which includes a segment of renal capsule at one end. There are twenty-one glomeruli counted, three of which are obsolete. The viable glomeruli are essentially unremarkable. The tubulointerstitium is quite impressive. There is a diffuse granulomatous acute and chronic interstitial nephritis that involves much of the cortex. The granulomas are non-caseating, but contain numerous giant cells. Special stains for fungal and acid fast organisms are negative. The vasculature is remarkable for mild to moderate intimal sclerosis of the small arteries and focal, mild hyalinosis of arterials. There are no thrombotic nor vasculitic lesions.

===Immunofluorescence:===

===Immunofluorescence===

Twelve glomeruli are available for study, all of them viable. There is diffuse, coarse granular staining of the mesangium for C3 (1+). The other immunoreactants (IgG, IgM, IgA, and Kappa and Lambda light chains) are negative. There is no significant staining of the tubulointerstitium or vasculature.

~~===Electron Microscopy:===~~

===Electron Microscopy===

Two glomeruli are available for study and are essentially unremarkable on ultrastructural exam. No immune complex-type deposits are identified.

</div></div>

Kidney, right, needle biopsy - Granulomatous interstitial nephritis.

This biopsy demonstrates a florid granulomatous interstitial nephritis. There is no evidence of acid-fast or fungal infection on special stains. There is no evidence for a granulomatous vasculitis. Leading considerations in the differential diagnosis are drug reaction and sarcoidosis, but other etiologies cannot be excluded histologically. Clinical correlation is recommended. Notably, despite the impressive inflammatory response in the interstitium, there is relatively mild irreversible tubulointerstitial injury at this time.

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@@ Line 1: / Line 1: @@
 '''CRP-51'''
 ==Clinical History==
+The patient is a 43 year old white woman with acute onset of a renal and hepatic disease 3-4 months prior to admission. Creatinine - 2.0; creatinine clearance - 57 cc/min; 24 hour protein - 0.7 grams. Serologies include normal C3/C4; negative ASO; negative SPEP; negative ANCAs. The renal ultrasound is normal.
-==Gross Description:==
+==Gross Description==
+Received in Carson's fixative is a single needle core that measures 15.0 x 1.0 mm. Two 1.0 mm pieces are separated for ultrastructural studies and the remainder is processed for light microscopy. An additional two cores that measure 10.0 and 11.0 mm in length and 1.0 mm each in diameter are received in Zeus fixative and are processed for immunofluorescence microscopy.
 ==Pathology==
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 <div class="mw-collapsible-content">
-==Microscopic Description:==
+==Microscopic Description==
-===Light Microscopy:===
+===Light Microscopy===
+Sections are of two needle cores of renal cortex, one of which includes a segment of renal capsule at one end. There are twenty-one glomeruli counted, three of which are obsolete. The viable glomeruli are essentially unremarkable. The tubulointerstitium is quite impressive. There is a diffuse granulomatous acute and chronic interstitial nephritis that involves much of the cortex. The granulomas are non-caseating, but contain numerous giant cells. Special stains for fungal and acid fast organisms are negative. The vasculature is remarkable for mild to moderate intimal sclerosis of the small arteries and focal, mild hyalinosis of arterials. There are no thrombotic nor vasculitic lesions.
-===Immunofluorescence:===
+===Immunofluorescence===
+Twelve glomeruli are available for study, all of them viable. There is diffuse, coarse granular staining of the mesangium for C3 (1+).  The other immunoreactants (IgG, IgM, IgA, and Kappa and Lambda light chains) are negative. There is no significant staining of the tubulointerstitium or vasculature.
-===Electron Microscopy:===
+===Electron Microscopy===
+Two glomeruli are available for study and are essentially unremarkable on ultrastructural exam. No immune complex-type deposits are identified.
 </div></div>
 <spoiler text="Diagnosis and Comments">
+Kidney, right, needle biopsy - Granulomatous interstitial nephritis.
+This biopsy demonstrates a florid granulomatous interstitial nephritis. There is no evidence of acid-fast or fungal infection on special stains. There is no evidence for a granulomatous vasculitis. Leading considerations in the differential diagnosis are drug reaction and sarcoidosis, but other etiologies cannot be excluded histologically.  Clinical correlation is recommended. Notably, despite the impressive inflammatory response in the interstitium, there is relatively mild irreversible tubulointerstitial injury at this time.
 </spoiler>