Renal Situational Week One

Renal module Week One: Primary Glomerulonephritis. Normando C. Gonzaga, M.D., F.P.S.P

Review of Histology

Below is the PAS stain of a normal glomerulus. Study the morphology and compare this with the subsequent cases. Describe the cellularity. How many cells should be present in the mesangial matrix?

Slide A. In slide A Locate the capillaries, mesangial stalk, and mesangial cells. 2 What are the functions of the mesangial cells?

Slide B.Identify the mesangial cells, endothelial cells, and the foot processes.

Slide C. Identify the foot processes, basement membrane, and visceral epithelial cell.

Slide D. 1. Identify the lamina densa, lamina rara externa, and lamina rara interna 2. What will be the terms used for dense deposits in the a. lamina densa. c. lamina rara externa, c. lamina rara interna

Case 1. A 10-year old boy consulted a physician because of tea colored urine and puffiness of the eyelids noted especially in the morning. This symptoms were noticed 3 weeks after he had fever and sore throat.

Slide 1-a:Below is the H& E section of the renal biopsy. Describe the glomerulus. particularly the cellularity and the leucocytic infiltrates

Slide 1-b:

IF of the case. What major antibodies

would be positive? Describe the classical appearance of IgG and C3.

Slide 1-c. Locate and describe the dense deposits. What makes this lesion acute and exudative based on this micrograph?

Case 2 A 16-year old female was discovered to have microscopic hematuria on routine urinalysis during the entrance physical examination. Immunofluorescent microscopy shows deposits of IgA in the mesangium and few deposits in the basement membrane.

Case 2.. Slide 2.a. Below is the appearance of immunofluorescence to IgA antibody. IgG and IgM are negative.

Slide 2.b. Describe this PAS-stained glomerulus of this case.

Slide 2.c.Below is another light microscopic pattern of this case. Describe the glomerulus.

Slide 2.d.Localize the dense deposits(D) of this case as shown in this micrograph.

Case 2 Summary  What

is your final diagnosis of this case?  What is the most important diagnostic tool in the diagnosis of this case?

Case 3. A 5-year old boy was noticed to have periorbital and pedal edema for the last 2 months. Urinalysis shows 3+ protein. Blood exam shows 40 g/L protein and 1.80 mmol/l cholesterol. Renal biopsy discloses normocellular glomeruli. Immunofluorescence is negative to all antibodies.

Below are the transmission electron microscope (left) and scannic electron microscope (right) findings.

Case 3. SummaryQuestions  What

is your diagnosis?  What is the most important diagnostic tool in the diagnosis of this lesion?  What is the prognosis?

Case 4. A 30 year-old male was diagnosed to have schistosomiasis a year ago. Two months prior to consultation, patient complained of generalized edema. Urinalysis shows 4+ protein. Blood exam: protein – 2.5 /L, cholesterol – 2.00 mmo/l

Below are the light microscopic findings: H& E (left), Silver impregnation(right)

The picture on the left shows the IF findings with IgG; on the right, the EM findings.

Case 4: Questions  What

is your diagnosis?  Describe the light microscopic findings as shown in the micrographs.  Describe the IF and EM findings as shown in the micrographs.  What is the relationship of Schistosomiasis with the renal lesion?

Case 5 A 25-year old female consulted a nephrologist because of blood in the urine. The physician after her physicaql examination find out that she has also generalized edema. Urinalysis showed 3+ protein. Blood chemistry revealed low protein and high triglycerides and cholesterol. On top of that her BP is 160/100.

Below are the PAS stain(left) and silver stain(right) of the renal biopsy.

Below are the EM findings.

Case 5: Questions  What

are the important light microscopic findings?  What is the most important immunofluorescence finding?  Describe the ultrastructural features which correspond to the light microscopic findings.  Differentiate the 3 types of this Glomerulonephritis.