Quiz page: March 2002
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A 54-year-old white woman had proteinuria (1.64 g/24 hr), microscopic hematuria, polymy- algia, a positive ANA, and normal serum creatinine. Figure 2A. What abnormalities do you see? (Jones’ silver stain, 400) The light microscopy shows mesangial expansion without mesangial cell increase. The glomerular basement membrane is irregular. The differential at this point includes both immune complex and scleros- ing processes. Figure 2B. What further abnormalities do you see in this higher power? (Jones’ silver stain, 1,000) There are irregular, long feathery spikes in a section of the glomerular basement membrane. The differential now includes immune complexes or the presence of other material infiltrating the basement membrane, resulting in this basement membrane reaction. The feathery spikes are too long and too segmental to be typical for idiopathic membranous glomerulonephritis. Amyloidosis should be considered. AJKD QUIZ PAGE ANSWERS MARCH 2002
Transcript of Quiz page: March 2002
A 54-year-old white woman had proteinuria (1.64 g/24 hr), microscopic hematuria, polymy-algia, a positive ANA, and normal serum creatinine.
Figure 2A. What abnormalities do you see? (Jones’ silver stain, �400)
The light microscopy shows mesangial expansion without mesangialcell increase. The glomerular basement membrane is irregular. Thedifferential at this point includes both immune complex and scleros-ing processes.
Figure 2B. What further abnormalities do you see in this higher power? (Jones’ silver stain, �1,000)
There are irregular, long feathery spikes in a section of the glomerular basement membrane. Thedifferential now includes immune complexes or the presence of other material infiltrating thebasement membrane, resulting in this basement membrane reaction. The feathery spikes aretoo long and too segmental to be typical for idiopathic membranous glomerulonephritis.Amyloidosis should be considered.
AJKD QUIZ PAGE ANSWERSMARCH 2002
Answer: AAAmyloidosis
Answer: AAAmyloidosis
Case provided by Agnes B. Fogo, MD, De-partment of Pathology, Vanderbilt UniversityMedical Center, Nashville, Tennessee.
If you have an interesting case you wouldlike to submit for consideration, please contactthe AJKD Editorial Office.
Figure 2C. Electron microscopy is crucial for further definition of the process. This examinationshows numerous randomly arranged, thin, non-branching fibrils. These are typical for amyloid. Whatfurther test do you need to definitively prove this diagnosis? (Transmission electron microscopy,�14,000)
Figure 2D. A Congo red stain is the gold standard for specific diagnosis of amyloid, since otherentities, such as fibrillary glomerulonephritis, may give rise to deposits with fibrillary substructure.The Congo red stain in this case shows apple-green birefringence when polarized, diagnostic ofamyloid. Immunostaining for AA amyloid was positive. (Congo red stain, �400)
AJKD QUIZ PAGE ANSWERS(continued)
