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====Mixed==== | ====Mixed==== | ||
*Features of nephritic syndrome and nephrotic syndrome. | *Features of nephritic syndrome and nephrotic syndrome. | ||
=Clinical DDx= | |||
The clinical presentations suggest a pathologic DDx.<ref>URL: [http://www.emedicine.com/med/topic886.htm http://www.emedicine.com/med/topic886.htm] and [http://www.emedicine.com/ped/topic1564.htm http://www.emedicine.com/ped/topic1564.htm]. Accessed on: 8 November 2010.</ref> | |||
===Nephritic=== | |||
*Post-infectious glomerulonephritis. | |||
**Classically streptococcal. | |||
*Crescentic glomerulonephritis ([[AKA]] rapidly progressive glomerulonephritis (RPGN)). | |||
====RPGN==== | |||
Classification:<ref>URL: [http://bestpractice.bmj.com/best-practice/monograph/207/basics/classification.html http://bestpractice.bmj.com/best-practice/monograph/207/basics/classification.html]. Accessed on: 17 November 2011.</ref> | |||
#Linear immune deposits. | |||
#*[[Antiglomerular basement membrane disease]] & Goodpasture's syndrome. | |||
#Granular immune deposits. | |||
#*Immune complex diseases. | |||
#**[[Systemic lupus erythematosus]]. | |||
#**[[IgA nephropathy]]. | |||
#**Others. | |||
#Pauci-immune. | |||
#*ANCA vasculitides. | |||
#**[[Wegener's granulomatosis]]. | |||
#**[[Microscopic polyangiitis]]. | |||
===Nephrotic=== | |||
*Minimal segmental disease (MSD) - [[AKA]] ''minimal change disease'' (MCD). | |||
*[[Focal segmental glomerulosclerosis]] (FSGS). | |||
*[[Membranous nephropathy]]. | |||
===Mixed presentation=== | |||
*[[IgA nephropathy]]. | |||
*[[Focal proliferative glomerulosclerosis]] (FPGS). | |||
*[[Membranoproliferative glomerulonephritis]] (MPGN). | |||
=Normal= | =Normal= | ||
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===Vessels=== | ===Vessels=== | ||
#Arteriolar hyalinosis - too much pink stuff? | #Arteriolar hyalinosis - too much glassy pink stuff? | ||
#Intimal hyperplasia. | #Intimal hyperplasia (atherosclerosis). | ||
Consider: | Consider: | ||
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*Amyloid? - pink. | *Amyloid? - pink. | ||
*Rejection? - PMNs. | *Rejection? - PMNs. | ||
*Cholesterol emboli? | |||
===Tubules & interstitium=== | ===Tubules & interstitium=== | ||
Tubules - proximal portion is the most important. | Tubules - proximal portion is the most important. | ||
*Casts? | *Casts? | ||
*Degeneration, i.e. apoptosis. | |||
*Necrosis? | *Necrosis? | ||
*Regeneration, e.g. mitoses. | |||
Interstitium | Interstitium | ||
*Fibrosis - prognostically important. | *Fibrosis - prognostically important. | ||
**Grading: mild = <25%, moderate 25-50%, severe >50%. | **Grading: mild = <25%, moderate 25-50%, severe >50%. | ||
*Inflammation? | |||
==Important terms/process related== | ==Important terms/process related== | ||
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*Severe: media < intima. | *Severe: media < intima. | ||
==Pathologic differential diagnosis== | |||
===Mesangial hypercellularity=== | ===Mesangial hypercellularity=== | ||
DDx: | DDx: | ||
# [[Lupus nephritis]]. | #[[Lupus nephritis]]. | ||
# [[IgA nephropathy]]. | #[[IgA nephropathy]]. | ||
===Mesangial expansion=== | ===Mesangial expansion=== | ||
DDx: | |||
*Diabetes mellitus.<ref name=pmid17418688>{{cite journal |author=Fioretto P, Mauer M |title=Histopathology of diabetic nephropathy |journal=Semin. Nephrol. |volume=27 |issue=2 |pages=195-207 |year=2007 |month=March |pmid=17418688 |doi=10.1016/j.semnephrol.2007.01.012 |url=}}</ref> | *Diabetes mellitus.<ref name=pmid17418688>{{cite journal |author=Fioretto P, Mauer M |title=Histopathology of diabetic nephropathy |journal=Semin. Nephrol. |volume=27 |issue=2 |pages=195-207 |year=2007 |month=March |pmid=17418688 |doi=10.1016/j.semnephrol.2007.01.012 |url=}}</ref> | ||
*Immune complex mediated disease | *Immune complex mediated disease | ||
*[[Henoch-Schoenlein purpura]]. | **[[IgA nephropathy]]. | ||
*Lupus. | **[[Henoch-Schoenlein purpura]]. | ||
**[[Lupus nephritis]]. | |||
===Glomerular crescents=== | ===Glomerular crescents=== | ||
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====Microscopic==== | ====Microscopic==== | ||
Features: | |||
*Crescentic-shaped lesion in the urinary space of a glomerulus. | *Crescentic-shaped lesion in the urinary space of a glomerulus. | ||
**Crescent = looks like the moon shortly after new moon. | **Crescent = looks like the moon shortly after new moon. | ||
**Cells & cellular debris in the urinary space. | |||
***Crescents lack GBM -- thus PAS -ve and MPAS -ve. | |||
*Break in the glomerular basement membrane - '''key feature'''. | *Break in the glomerular basement membrane - '''key feature'''. | ||
**Best seen on a silver stain (e.g. [[Jones stain]]). | **Best seen on a silver stain (e.g. [[Jones stain]]). | ||
*Fibrin. | *Fibrin. | ||
** | **Orange on [[HPS stain|HPS]]. | ||
* | **Pink on [[H&E stain|H&E]]. | ||
*Inflammatory cells (lymphocytes, plasma cells, eosinophils, macrophages) - extravascular - '''low power''' feature. | *Inflammatory cells (lymphocytes, plasma cells, eosinophils, macrophages) - extravascular - '''low power''' feature. | ||
DDx: | DDx: | ||
*Glomerular sclerosis: | *Glomerular sclerosis: | ||
** | **GBM visible through-out glomerulus. | ||
**No fibrin. | **No fibrin. | ||
**Collagen deposition within the glomerular tuft. | **Collagen deposition within the glomerular tuft. | ||
***Seen with [[trichrome stain]]. | ***Seen with [[trichrome stain]]. | ||
**+/-Glomerular tuft-capsule adhesions. | |||
**+/-Glomerular enlargement. | |||
**Usu. no significant inflammation. | |||
====Bland necrotic crescents==== | ====Bland necrotic crescents==== | ||
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Diseases with crescents - is a long list.<ref>URL: [http://path.upmc.edu/cases/case51/dx.html http://path.upmc.edu/cases/case51/dx.html]. Accessed on: 9 November 2010.</ref> | Diseases with crescents - is a long list.<ref>URL: [http://path.upmc.edu/cases/case51/dx.html http://path.upmc.edu/cases/case51/dx.html]. Accessed on: 9 November 2010.</ref> | ||
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{{Main|Systemic lupus erythematosus}} | {{Main|Systemic lupus erythematosus}} | ||
*Bread & butter of nephropathology. | *Bread & butter of nephropathology. | ||
*The biopsy done to determine treatment, i.e. how much immunosuppression is needed. | *The biopsy is done to determine treatment, i.e. how much immunosuppression is needed. | ||
===Immunofluorescence=== | ===Immunofluorescence=== | ||
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*Class I - minimal mesangial LN. | *Class I - minimal mesangial LN. | ||
*Class II - mesangial proliferative LN. | *Class II - mesangial proliferative LN. | ||
**Mesangial hypercellularity. (???) | |||
*Class III - focal lupus nephritis; <50% of glomeruli. | *Class III - focal lupus nephritis; <50% of glomeruli. | ||
*Class VI-S - diffuse segmental LN; >50% of glomeruli. | **Mesangial hypercellularity. (???) | ||
*Class VI-S - diffuse segmental LN; >50% of glomeruli. | |||
**Mesangial hypercellularity. (???) | |||
*Class VI-G - global LN; >50% of glomeruli. | *Class VI-G - global LN; >50% of glomeruli. | ||
*Class V - Membranous lupus nephritis. | *Class V - Membranous lupus nephritis. | ||
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*In adults most common cause: ''hepatitis C''. | *In adults most common cause: ''hepatitis C''. | ||
Clinical: | |||
*Nephrotic syndrome or nephrotic/nephritic syndrome. | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
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DDx: | DDx: | ||
#Linear immunofluorescence. | #Linear immunofluorescence. | ||
#*[[Antiglomerular basement membrane disease]] | #*[[Antiglomerular basement membrane disease]], [[Goodpasture syndrome]]. | ||
#Granular immunofluorescence | #Granular immunofluorescence | ||
#*[[Lupus nephritis]]. | #*[[Lupus nephritis]]. | ||
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Features: | Features: | ||
*[[Glomerular crescents]]. | *[[Glomerular crescents]]. | ||
*Interstitial inflammation. | |||
*+/-[[Vasculitis]]. | |||
Image: | Image: | ||
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Features: | Features: | ||
*+/-Neutrophils - in glomerulus. | *+/-Neutrophils - in glomerulus. | ||
*[[Glomerular crescents]]. | |||
Image: | Image: | ||
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==Idiopathic nodular glomerulosclerosis== | ==Idiopathic nodular glomerulosclerosis== | ||
===General=== | ===General=== | ||
*Not [[diabetes mellitus|diabetic]] '''key feature'''. | *Not [[diabetes mellitus|diabetic]] - '''key feature'''. | ||
Associations:<ref name=pmid18701135/> | Associations:<ref name=pmid18701135/> |
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