CRP-05: Difference between revisions - Pathology Education Instructional Resource

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'''CRP-05'''

==Clinical History==

The patient is a 21 year old black female.

==Gross Description:==

Persistent proteinuria postpartum. Urinary Protein 800 mg/24 hr. Creatinine 0.6.

==Gross Description==

None given.

==Pathology==

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<peir-vm>specialcrp/CRP-005_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>

==Microscopic Description:==

==Microscopic Description==

===Light Microscopy~~:===~~

===Light Microscopy===

The specimen consists of two fragments of renal cortex, one of which contains a small portion of medulla. There are 52 glomeruli in the three levels. One of these at the corticomedullary junction is obsolete, but the remainder are similar and show mild mesangial expansion and hypercellularity. No segmental sclerosis is identified. The capillary basement membranes appear somewhat fuzzy with the PASH stain, and numerous spikes and holes are identified with the silver stain. There is minimal interstitial fibrosis, and there is no significant tubular atrophy. There are no inflammatory infiltrates. The arterioles and small arteries are unremarkable.

~~===Immunofluorescence:~~===

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

===Immunofluorescence===

There are twenty-seven glomeruli in the sections. There is diffuse granular capillary loop staining that is graded 3+ for IgG and kappa and lambda light chains. There is trace mesangial and capillary loop staining for C3, and there is also 1+ mesangial staining for IgM. There is no glomerular staining for IgA or Clq. There is no staining of the tubular basement membranes.

Arterioles show focal mild staining for C3.

===Electron Microscopy===

Two thick sections containing a total of seven glomeruli are available. These are similar to those described above and show mild mesangial expansion and irregular marked thickening of the capillary basement membranes. Ultrastructural examination confirms the basement membrane thickening, and there is diffuse fusion of the epithelial cell foot processes. Numerous epimembranous, subepithelial and intramembranous electron dense deposits are present along the basement membranes. Some of the deposits are undergoing resorption. No subendothelial deposits are noted. Mesangial areas contain increased matrix, but no deposits are identified.

</div></div>

Kidney, needle biopsy- Membranous nephropathy, stage IV.

</spoiler>

@@ Line 1: / Line 1: @@
 '''CRP-05'''
 ==Clinical History==
+The patient is a 21 year old black female.
-==Gross Description:==
+Persistent proteinuria postpartum.  Urinary Protein 800 mg/24 hr. Creatinine 0.6.
+==Gross Description==
+None given.
 ==Pathology==
@@ Line 12: / Line 16: @@
 <peir-vm>specialcrp/CRP-005_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-content">
-==Microscopic Description:==
+==Microscopic Description==
-===Light Microscopy:===
+===Light Microscopy===
+The specimen consists of two fragments of renal cortex, one of which contains a small portion of medulla. There are 52 glomeruli in the three levels. One of these at the corticomedullary junction is obsolete, but the remainder are similar and show mild mesangial expansion and hypercellularity. No segmental sclerosis is identified. The capillary basement membranes appear somewhat fuzzy with the PASH stain, and numerous spikes and holes are identified with the silver stain. There is minimal interstitial fibrosis, and there is no significant tubular atrophy. There are no inflammatory infiltrates. The arterioles and small arteries are unremarkable.
-===Immunofluorescence:===
-===Electron Microscopy:===
+===Immunofluorescence===
+There are twenty-seven glomeruli in the sections. There is diffuse granular capillary loop staining that is graded 3+ for IgG and kappa and lambda light chains. There is trace mesangial and capillary loop staining for C3, and there is also 1+ mesangial staining for IgM. There is no glomerular staining for IgA or Clq. There is no staining of the tubular basement membranes.
+Arterioles show focal mild staining for C3.
+===Electron Microscopy===
+Two thick sections containing a total of seven glomeruli are available. These are similar to those described above and show mild mesangial expansion and irregular marked thickening of the capillary basement membranes. Ultrastructural examination confirms the basement membrane thickening, and there is diffuse fusion of the epithelial cell foot processes. Numerous epimembranous, subepithelial and intramembranous electron dense deposits are present along the basement membranes. Some of the deposits are undergoing resorption. No subendothelial deposits are noted. Mesangial areas contain increased matrix, but no deposits are identified.
 </div></div>
 <spoiler text="Diagnosis and Comments">
+Kidney, needle biopsy- Membranous nephropathy, stage IV.
 </spoiler>