CRP-02: Difference between revisions - Pathology Education Instructional Resource

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

'''CRP-02'''

== Clinical History==

The patient is a 46 year old male.

BUN 22, creatinine 0.8, Creatinine clearance 130 ml/min, urinary protein 11 .8 g/24 hr. BP 152/102.

==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.

==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>

==Microscopic Description==

===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.

===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.

===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.

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.

</div></div>

Kidney, needle biopsy· Membranous nephropathy, Stage III.

</spoiler>

@@ Line 1: / Line 1: @@
-== [[CRP-02|CRP-02]] ==
+'''CRP-02'''
+== Clinical History==
+The patient is a 46 year old male.
+BUN 22, creatinine 0.8, Creatinine clearance 130 ml/min, urinary protein 11 .8 g/24 hr. BP 152/102.
+==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.
+==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 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===
+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===
+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.
+</div></div>
+<spoiler text="Diagnosis and Comments">
+Kidney, needle biopsy· Membranous nephropathy, Stage III.
+</spoiler>