CRP-52
CRP-52
Clinical History
The patient is a 66 year old male. BUN 47, creatinine 4.7.
Gross Description
Received in Zeus fixative are two cores measuring 7 and 20 mm in length and 1 mm in diameter. These are entirely submitted for immunofluorescence. Received in Carson's fixative are four cores measuring 9, 8, 13, and 4 mm in length and mm in diameter. Three 1-mm pieces are taken for EM, and the remaining tissue is submitted for light microscopy.
Pathology
Case CRP-052 H&E
Case CRP-052 PASH
Microscopic Description
Light Microscopy
The specimen consists of multiple small fragments of renal cortex that contain twenty glomeruli in the three levels. Three of these are globally sclerotic, but the remainder show good preservation with no significant mesangial expansion or hypercellularity. The glomerular basement membranes are unremarkable with the silver stain. The PASH and trichrome stains show diffuse moderate interstitial fibrosis and focal tubular atrophy. However, there is also diffuse interstitial edema with numerous mononuclear inflammatory cells. The infiltrate is composed primarily of lymphocytes with occasional plasma cells and rare eosinophils. Many examples of tubulitis are identified. Several arteries show severe intimal fibrous thickening.
Immunofluorescence
There are four glomeruli in the sections. Stains for IgG, IgM, IgA, Clq, C3, albumin and light chains are negative in the glomeruli. There is no staining of the tubular basement membranes or vessels.
Electron Microscopy
Three thick sections containing a total of two glomeruli are available. Ultrastructural examination of one glomerulus reveals no significant mesangial expansion or hypercellularity. The glomerular basement membranes are of normal thickness, and the foot processes are intact. No electron dense deposits are identified. Numerous examples of emperipolesis are identified in the proximal tubules.