OS 214 [A]: Digestive and Excretory
description
Transcript of 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
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
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
No mesangial and endothelial proliferation
Segmental sclerosis(-) Mesangial and endothelial proliferationThin and delicate capillary loops (normal)
Silver stain*
Silver stain
Segmental sclerosis
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
Global sclerosis
Tubular atrophy
Collagen deposition in Bowman’s space, not crescent*
Colloid casts*
Inflammatory interstitial infiltrates
Normal tubules
Inflammatory interstitial infiltrates
H&E
Colloid cast
Arteriole
Calcification* inside a tubule
Global sclerosis (2)Colloid castsTubular atrophy
Colloid cast
Arterioles
Tubular atrophy
Normal tubules
Masson Trichome Stain
Fibrosis(blue green)
1+ trace 1+
Trace-1+
54
1 – Mesangial cells2 – Endothelial cell*3 – Capillary loops4 – Parietal epithelial cell5 – Bowman’s capsule – Effaced foot processes2
31
1
3
Capillary loop
No deposits in GBM
Preserved endothelial fenestrations
Effaced foot processes
No deposits in GBM
Preserved endothelial fenestrations
Effaced foot processes
Effaced foot processes
Effaced foot processes
1 – Nuclei of mesangial cells2 – Cytoplasm of mesangial cells3 – Mesangial matrix
2
1
1
2
3No mesangial deposits
Summary of Findings• LM: FSGS• IF: None• EM: Foot process effacement
NIKA, ADA, GUDOLab 01.3: Lab Skills Session – Case 2
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