OS 214 [A]: Digestive and Excretory

25
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

description

2. OS 214 [A]: Digestive and Excretory. Lab 01.3: Lab Skills Session – Case 2. March 12, 2014. Dr. Sonia L. Chicano. NIKA, ADA, GUDO. History and PE. 68/F, known diabetic, presenting with a 5-mo history of hyperpigmented patches on both LE - PowerPoint PPT Presentation

Transcript of OS 214 [A]: Digestive and Excretory

Page 1: OS  214 [A]:  Digestive and  Excretory

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

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

Page 3: OS  214 [A]:  Digestive and  Excretory

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

Page 4: OS  214 [A]:  Digestive and  Excretory

No mesangial and endothelial proliferation

Page 5: OS  214 [A]:  Digestive and  Excretory

Segmental sclerosis(-) Mesangial and endothelial proliferationThin and delicate capillary loops (normal)

Silver stain*

Page 6: OS  214 [A]:  Digestive and  Excretory

Silver stain

Segmental sclerosis

Page 7: OS  214 [A]:  Digestive and  Excretory

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

Page 8: OS  214 [A]:  Digestive and  Excretory

Global sclerosis

Page 9: OS  214 [A]:  Digestive and  Excretory

Tubular atrophy

Collagen deposition in Bowman’s space, not crescent*

Page 10: OS  214 [A]:  Digestive and  Excretory

Colloid casts*

Inflammatory interstitial infiltrates

Normal tubules

Page 11: OS  214 [A]:  Digestive and  Excretory

Inflammatory interstitial infiltrates

H&E

Colloid cast

Arteriole

Page 12: OS  214 [A]:  Digestive and  Excretory

Calcification* inside a tubule

Page 13: OS  214 [A]:  Digestive and  Excretory

Global sclerosis (2)Colloid castsTubular atrophy

Page 14: OS  214 [A]:  Digestive and  Excretory

Colloid cast

Arterioles

Tubular atrophy

Page 15: OS  214 [A]:  Digestive and  Excretory

Normal tubules

Page 16: OS  214 [A]:  Digestive and  Excretory

Masson Trichome Stain

Fibrosis(blue green)

Page 17: OS  214 [A]:  Digestive and  Excretory

1+ trace 1+

Trace-1+

Page 18: OS  214 [A]:  Digestive and  Excretory

54

1 – Mesangial cells2 – Endothelial cell*3 – Capillary loops4 – Parietal epithelial cell5 – Bowman’s capsule – Effaced foot processes2

31

1

3

Page 19: OS  214 [A]:  Digestive and  Excretory

Capillary loop

Page 20: OS  214 [A]:  Digestive and  Excretory

No deposits in GBM

Preserved endothelial fenestrations

Effaced foot processes

Page 21: OS  214 [A]:  Digestive and  Excretory

No deposits in GBM

Preserved endothelial fenestrations

Effaced foot processes

Page 22: OS  214 [A]:  Digestive and  Excretory

Effaced foot processes

Effaced foot processes

Page 23: OS  214 [A]:  Digestive and  Excretory

1 – Nuclei of mesangial cells2 – Cytoplasm of mesangial cells3 – Mesangial matrix

2

1

1

2

3No mesangial deposits

Page 24: OS  214 [A]:  Digestive and  Excretory

Summary of Findings• LM: FSGS• IF: None• EM: Foot process effacement

NIKA, ADA, GUDOLab 01.3: Lab Skills Session – Case 2

Page 25: OS  214 [A]:  Digestive and  Excretory

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