Difference between revisions of "Medical kidney diseases"

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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==
Five classes:
===General===
*Diffuse mesangial 2 vs. 4.
Bread & butter of nephropathology.
*Focal patch mesangial 3.
 
*Membranous 5 ???
===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 in myeloma==
==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 also: ''[[Medical liver disease]]''.


===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>
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