CRP-13: Difference between revisions - Pathology Education Instructional Resource

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'''CRP-13'''

==Clinical History==

The patient is a 21 year old white female. BUN 56, creatinine 8.8, creatinine clearance 8 ml/min, urinary protein 3.4 g/day. Strongly positive anti-GBM. C-ANCA and P-ANCA negative. Previous biopsy showed "granulomatous glomerulonephritis. Immunofluorescence staining in that biopsy was suggestive of linear staining for IgG, but the background was reported as high, so a definite diagnosis of anti-GBM glomerulonephritis was not made.

==Gross Description:==

Received in transport medium are two cores measuring 12 and 15 mm in length and 2 mm in diameter. Four 1-mm pieces are taken for EM, and the remaining tissue is bisected and equally divided for immunofluorescence and light microscopy.

==Pathology==

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===Case CRP-013 Silver===

<peir-vm>specialcrp/CRP-013_Silver</peir-vm>

===Case CRP-013 Trichrome===

<peir-vm>specialcrp/CRP-013_Trichrome</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>

==Microscopic Description:==

==Microscopic Description==

===Light Microscopy:===

===Light Microscopy===

The specimen consists of four fragments of renal cortex that contain a total of sixty-three glomeruli in the three levels. Five of these are globally sclerotic, and the remaining glomeruli demonstrate exuberant crescent formation and marked compression of the glomerular tufts. About one third of the glomeruli also show segmental fibrinoid necrosis. There does not appear to be significant mesangial proliferation, and the glomerular basement membranes that are still intact show no spike formation or splitting. The PASH and trichrome stains show diffuse mild interstitial fibrosis, but there is minimal tubular atrophy. There is mild interstitial edema, and focal collections of mononuclear inflammatory cells are present. These are associated with occasional examples of tubulitis. The vasculature is adequately sampled and is unremarkable.

===Immunofluorescence:===

===Immunofluorescence===

There are nine glomeruli in the sections, and all of them contain large cellular crescents. There is diffuse linear staining along the capillary basement membranes that is graded 4+ for IgG and kappa and 1+ for lambda. There is also focal and segmental 1+ linear staining for C3 along the basement membranes. There is 1+ focal and segmental mesangial staining for IgM. There is no mesangial staining for IgG, IgA, Clq, C3 or light chains. There is no staining of the tubular basement membranes. There is 1+ staining for C3 in the vessel walls.

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

===Electron Microscopy===

Three thick sections containing a total of six glomeruli are available. All of these contain large cellular crescents, and there is also focal necrosis. Ultrastructural examination reveals marked compression of the glomerular capillaries, and the foot processes are completely effaced. Occasional breaks in the glomerular basement membranes are identified. There are no electron dense deposits in the glomeruli.

</div></div>

Kidney, needle biopsy - Anti-GBM glomerulonephritis.

These findings are most consistent with anti-glomerular basement membrane glomerulonephritis. Although there is still relatively mild tubulointerstitial scarring, the severity and extent of the glomerular lesions suggest that progression of the lesion with significant scarring is inevitable.

</spoiler>

@@ Line 1: / Line 1: @@
 '''CRP-13'''
 ==Clinical History==
+The patient is a 21 year old white female. BUN 56, creatinine 8.8, creatinine clearance 8 ml/min, urinary protein 3.4 g/day. Strongly positive anti-GBM. C-ANCA and P-ANCA negative. Previous biopsy showed "granulomatous glomerulonephritis. Immunofluorescence staining in that biopsy was suggestive of linear staining for IgG, but the background was reported as high, so a definite diagnosis of anti-GBM glomerulonephritis was not made.
 ==Gross Description:==
+Received in transport medium are two cores measuring 12 and 15 mm in length and 2 mm in diameter. Four 1-mm pieces are taken for EM, and the remaining tissue is bisected and equally divided for immunofluorescence and light microscopy.
 ==Pathology==
@@ Line 11: / Line 13: @@
 ===Case CRP-013 Silver===
 <peir-vm>specialcrp/CRP-013_Silver</peir-vm>
+===Case CRP-013 Trichrome===
+<peir-vm>specialcrp/CRP-013_Trichrome</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-content">
-==Microscopic Description:==
+==Microscopic Description==
-===Light Microscopy:===
+===Light Microscopy===
+The specimen consists of four fragments of renal cortex that contain a total of sixty-three glomeruli in the three levels. Five of these are globally sclerotic, and the remaining glomeruli demonstrate exuberant crescent formation and marked compression of the glomerular tufts. About one third of the glomeruli also show segmental fibrinoid necrosis. There does not appear to be significant mesangial proliferation, and the glomerular basement membranes that are still intact show no spike formation or splitting. The PASH and trichrome stains show diffuse mild interstitial fibrosis, but there is minimal tubular atrophy. There is mild interstitial edema, and focal collections of mononuclear inflammatory cells are present. These are associated with occasional examples of tubulitis. The vasculature is adequately sampled and is unremarkable.
-===Immunofluorescence:===
+===Immunofluorescence===
+There are nine glomeruli in the sections, and all of them contain large cellular crescents. There is diffuse linear staining along the capillary basement membranes that is graded 4+ for IgG and kappa and 1+ for lambda. There is also focal and segmental 1+ linear staining for C3 along the basement membranes. There is 1+ focal and segmental mesangial staining for IgM. There is no mesangial staining for IgG, IgA, Clq, C3 or light chains. There is no staining of the tubular basement membranes. There is 1+ staining for C3 in the vessel walls.
-===Electron Microscopy:===
+===Electron Microscopy===
+Three thick sections containing a total of six glomeruli are available. All of these contain large cellular crescents, and there is also focal necrosis. Ultrastructural examination reveals marked compression of the glomerular capillaries, and the foot processes are completely effaced. Occasional breaks in the glomerular basement membranes are identified. There are no electron dense deposits in the glomeruli.
 </div></div>
 <spoiler text="Diagnosis and Comments">
+Kidney, needle biopsy - Anti-GBM glomerulonephritis.
+These findings are most consistent with anti-glomerular basement membrane glomerulonephritis. Although there is still relatively mild tubulointerstitial scarring, the severity and extent of the glomerular lesions suggest that progression of the lesion with significant scarring is inevitable.
 </spoiler>