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Difference between revisions of "Medical kidney diseases"
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Medical kidney diseases (view source)
Revision as of 04:27, 10 November 2010
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*WBC casts = interstitial nephritis, e.g. pylonephritis, parenchymal infection. | *WBC casts = interstitial nephritis, e.g. pylonephritis, parenchymal infection. | ||
*Hemegranular casts = acute tubular necrosis, transplant rejection. | *Hemegranular casts = acute tubular necrosis, transplant rejection. | ||
Notes: | |||
*"Active sediment" = RBCs, RBC casts;<ref>URL: [http://emedicine.medscape.com/article/238158-overview http://emedicine.medscape.com/article/238158-overview]. Accessed on: 9 November 2010.</ref> implies glomerulonephritis. | |||
**Some include the above (RBCs, RBC casts) + WBCs & protein.<ref>URL: [http://www.nephrologychannel.com/agn/index.shtml http://www.nephrologychannel.com/agn/index.shtml]. Accessed on: 9 November 2010.</ref> | |||
====Urine crystals==== | ====Urine crystals==== | ||
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==Lupus nephritis== | ==Lupus nephritis== | ||
===General=== | |||
* | Bread & butter of nephropathology. | ||
* | |||
* | ===Classification/Grading=== | ||
International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification:<ref>{{cite journal |author=Weening JJ, D'Agati VD, Schwartz MM, ''et al.'' |title=The classification of glomerulonephritis in systemic lupus erythematosus revisited |journal=J. Am. Soc. Nephrol. |volume=15 |issue=2 |pages=241–50 |year=2004 |month=February |pmid=14747370 |doi= |url=http://www.nature.com/ki/journal/v55/n2/full/4490631a.html}}</ref> | |||
*Class I. | |||
*Class II. | |||
*Class III. | |||
*Class VI. | |||
*Class V. | |||
*Class IV. | |||
Notes: | Notes: | ||
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*Autosomal dominant - 5%. | *Autosomal dominant - 5%. | ||
==Cast nephropathy | ==Myeloma== | ||
===Cast nephropathy=== | |||
Features: | |||
*Cast with cellular reaction. | |||
**Macrophages (CD68 +ve). | |||
Stains: | |||
*Myeloma casts = PAS -ve. | |||
**Hyaline casts = PAS +ve. | |||
See: ''[[haematopathology]]''. | See: ''[[haematopathology]]''. | ||
===Amyloidosis=== | |||
*Usually associated with lambda clone. | |||
===Light chain deposition=== | |||
*Usually associated with kappa clone. | |||
===Microscopic=== | ===Microscopic=== | ||
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**Surrounded by collagenous stroma. | **Surrounded by collagenous stroma. | ||
See: ''[[Medical liver disease]]''. | |||
See | |||
===Gross=== | ===Gross=== | ||
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==Transplant== | ==Transplant== | ||
===General=== | |||
Rejection can be: | |||
*Acute. | |||
*Chronic. | |||
*Acute-on-chronic. | |||
====Acute==== | |||
*Acute rejection has a standardized classification ''Banff classification''.<ref name=pmid9987096>{{cite journal |author=Racusen LC, Solez K, Colvin RB, ''et al.'' |title=The Banff 97 working classification of renal allograft pathology |journal=Kidney Int. |volume=55 |issue=2 |pages=713–23 |year=1999 |month=February |pmid=9987096 |doi=10.1046/j.1523-1755.1999.00299.x |url=http://www.nature.com/ki/journal/v55/n2/full/4490631a.html}}</ref> | |||
Diagnosis of acute rejection requires: | |||
#Serology. | |||
#IHC (C4d). | |||
#*This is somewhat debated. | |||
#Morphology. | |||
===Predictors=== | ===Predictors=== | ||
*Associated with C4d+ IHC.<ref name=pmid1747954>Vascular deposition of complement-split products in kidney allografts with cell-mediated rejection. Feucht HE, Felber E, Gokel MJ, Hillebrand G, Nattermann U, Brockmeyer C, Held E, Riethmüller G, Land W, Albert E. Clin Exp Immunol. 1991 Dec;86(3):464-70. PMID 1747954.</ref> | *Associated with C4d+ IHC.<ref name=pmid1747954>Vascular deposition of complement-split products in kidney allografts with cell-mediated rejection. Feucht HE, Felber E, Gokel MJ, Hillebrand G, Nattermann U, Brockmeyer C, Held E, Riethmüller G, Land W, Albert E. Clin Exp Immunol. 1991 Dec;86(3):464-70. PMID 1747954.</ref> | ||