OS 214 [A]: Digestive and Excretory Lab 01.3: Lab Skills Session – Case 2 Dr. Sonia L. Chicano...
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Transcript of OS 214 [A]: Digestive and Excretory Lab 01.3: Lab Skills Session – Case 2 Dr. Sonia L. Chicano...
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OS 214 [A]: Digestive and ExcretoryLab 01.3: Lab Skills Session – Case 2
Dr. Sonia L. Chicano
March 12, 2014
2
NIKA, ADA, GUDO
![Page 2: OS 214 [A]: Digestive and Excretory Lab 01.3: Lab Skills Session – Case 2 Dr. Sonia L. Chicano March 12, 2014 2 NIKA, ADA, GUDO.](https://reader036.fdocuments.net/reader036/viewer/2022081602/551b472f550346dd1a8b59d6/html5/thumbnails/2.jpg)
History and PE
• 68/F, known diabetic, presenting with a 5-mo history of hyperpigmented patches on both LE
• She later developed grade 3 bipedal edema, frothy urine, occasional tea-colored urine, and right flank pain.
NIKA, ADA, GUDOLab 01.3: Lab Skills Session – Case 2
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Work-Up
• Work-ups revealed consistent hematuria on urinalysis but with (-) dysmorphic RBCs.
• Proteinuria was in the nephrotic range, and serum creatinine was 188.
• She was started on enalapril and losartan for proteinuria, and she was admitted for kidney biopsy.
• ANA (+), normal C3NIKA, ADA, GUDOLab 01.3: Lab Skills Session – Case 2
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No mesangial and endothelial proliferation
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Segmental sclerosis(-) Mesangial and endothelial proliferationThin and delicate capillary loops (normal)
Silver stain*
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Silver stain
Segmental sclerosis
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What’s the pattern?
• For case 2: 27 glomeruli– 10 global sclerosis– 1 segmental sclerosis
• 1 out of 27 Focal segmental glomerulosclerosis (FSGS)
NIKA, ADA, GUDOLab 01.3: Lab Skills Session – Case 2
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Global sclerosis
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Tubular atrophy
Collagen deposition in Bowman’s space, not crescent*
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Colloid casts*
Inflammatory interstitial infiltrates
Normal tubules
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Inflammatory interstitial infiltrates
H&E
Colloid cast
Arteriole
![Page 12: OS 214 [A]: Digestive and Excretory Lab 01.3: Lab Skills Session – Case 2 Dr. Sonia L. Chicano March 12, 2014 2 NIKA, ADA, GUDO.](https://reader036.fdocuments.net/reader036/viewer/2022081602/551b472f550346dd1a8b59d6/html5/thumbnails/12.jpg)
Calcification* inside a tubule
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Global sclerosis (2)Colloid castsTubular atrophy
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Colloid cast
Arterioles
Tubular atrophy
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Normal tubules
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Masson Trichome Stain
Fibrosis(blue green)
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1+ trace 1+
Trace-1+
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54
1 – Mesangial cells2 – Endothelial cell*3 – Capillary loops4 – Parietal epithelial cell5 – Bowman’s capsule – Effaced foot processes2
31
1
3
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Capillary loop
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No deposits in GBM
Preserved endothelial fenestrations
Effaced foot processes
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No deposits in GBM
Preserved endothelial fenestrations
Effaced foot processes
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Effaced foot processes
Effaced foot processes
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1 – Nuclei of mesangial cells2 – Cytoplasm of mesangial cells3 – Mesangial matrix
2
1
1
2
3
No mesangial deposits
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Summary of Findings
• LM: FSGS• IF: None• EM: Foot process effacement
NIKA, ADA, GUDOLab 01.3: Lab Skills Session – Case 2
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Diagnosis
• FSGS with 76% global GS (31/41 glomeruli) and 15% segmental GS (4/41 glomeruli)
• Moderate interstitial fibrosis and tubular atrophy
• R/O: 2º FSGS
NIKA, ADA, GUDOLab 01.3: Lab Skills Session – Case 2