kidney clinical correlation

8/13/2019 Kidney Clinical Correlation

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Kidney

Clinical Correlation.

30thSeptember 2013.


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Normal glomerulus (arrow)


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Case -1

A six year old boy is brought byhis parents with a c/o severeabdominal pain, joint pains andpurpuric lesions on the extensorsurfaces of arms and legs and onthe buttocks.

He also complains of passingcola-colored urine.

A correct statement regardingthis disorder is :

a) Presence of subepithelial deposits.Memb. nephropathy

b) Basement-membrane splitting -MPGN

c) Immune complex vasculitis.

d) Irregular thickening of the GBM-Diabetic glomerulonephropathy

e) Uniform, diffuse thickening of the

GBM- Membranous nephropathyHere is the microscopy:


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HSP Clinical photograph-purpuric

rashes.


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Answer : C : Immune complex

vasculitis- HSP.*See p 666


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Case-2A 42 year old male presents

with recurrent episodes ofpurulent sinusitis and tworecent attacks of necrotizingpneumonitis. He also hasulcerations of the nasal mucosa

that are resistant to healing.

Investigations : increased BUNand creatinine .

A renal biopsy revealed a

necrotizing glomerulonephritis . A correct statement

regarding this :

a. Ig G and C3 immunedeposits along the GBM.

b. Paucity of immunecomplex deposits.

c. IgA deposits in themesangium

d. 3 chain of COL4mutation.

e. Deposition of amorphouseosinophilic Congo redpositive material in theglomerulus.


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Case-2A 42 year old male presents with

recurrent episodes of purulentsinusitis and two recent attacks ofnecrotizingpneumonitis. He alsohas ulcerations of the nasalmucosa that are resistant to

healing.Investigations : increased BUN andcreatinine .

A renal biopsy revealed anecrotizing glomerulonephritis .

A correct statement regardingthis :

a. Ig G and C3 immune depositsalong the GBM. DPGN ormembranous nephropathy

b. Paucity of immune complexdeposits.

c. IgA deposits in themesangium Bergers

d. 3 chain of COL4 mutation.Alport

e. Deposition of amorphouseosinophilic Congo redpositive material in theglomerulus. Amyloidosis


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Answer-B Pauci immune

Wegeners Granulomatosis*See p 516.


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Wegeners Clinical picture

Massive crusting andinflammation of the nasal

mucosa.

Saddle nose


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Wegener.

Necrotizing GN- early

lesion

Lung lesion

Vasculitis.

Later-Crescentic GN
http://www.google.com.ag/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=a3DtK1NJtSFhMM&tbnid=o6vM46FCAnPNeM:&ved=0CAUQjRw&url=http://www.humpath.com/spip.php?article3995&ei=mlxIUtrPHonc9ASZ2oGQBw&bvm=bv.53217764,d.eWU&psig=AFQjCNGFTSP37Ae-RJY137SzLrD036uwsA&ust=1380560398301257


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Case-3

A 8 year old male presentswith swelling of his face andalso around the ankles. Hismother says he had a mildrespiratory infection, a few days

ago.PE : reveals peripheral edema.

Urinalysis : 3 + proteinuria.

No red cell casts seen

24hour protein : 4.0 g

protein.A correct statementregarding this disorder is :

a. Non selective proteinuria-FSGS

b. Hyperlipidemia

c. No change in cholesterol

levels.d. Increase in polyanioniccontent of GBM.

e. Hypercellular glomeruli with

PMN infiltration on LM

Answer : B


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Nephrotic syndrome.


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MCD

Minimal Change Disease:

Features: Absence ofimmune complexes, butstrong evidence of an

immunologic basis. On LM and IFM = No

changes

EM : diffuse loss or fusionof foot processes

Dramatic response toprednisone therapy

Selective proteinuria


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Case - 4

A 68 year-old male who was a heavysmoker c/o fullness in the abdomenand hematuria.

Investigations show :

Polycythemia and hypercalcemia.

Urine : RBC ++ Cytology of the sediment shows

suspicious cells.

Abdominal CT : mass in the upperpole of kidney extending mediallyto the hilum.

A correct statement regarding thislesion is :

a. Eosinophilic fractured casts inthe tubules with giant cellreaction.

b. Tumor composed of clear cellswith a propensity to invade therenal vein .

c. Small blue, round cell tumorshowing triphasic pattern.wilms

d. Asymmetric scarred kidneys,with blunting of calyces.chronicpyelonephritis

e. High incidence in patients withthe WAGR syndrome.- wilms


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Diagnosis-RCC

Clear cells


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Case-5

This is the clinical photograph of a 2 year old child broughtto the pediatrician by his parents.

Surgery was done and the gross and microscopic picturesare shown in the next slide.
http://www.google.com.ag/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=c3Rtb0RnfLEnzM&tbnid=NMrfAY_rTfEo0M:&ved=0CAUQjRw&url=http://www.e-radiography.net/radpath/w/Wilms.htm&ei=4GFIUtD9Foj69gTOzYGQCw&psig=AFQjCNFQzHRO2AVSK6TOZwycdreKykVRkQ&ust=1380561405029459http://www.google.com.ag/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=oNu9rR_C7SLulM&tbnid=zsM7wiYCc_2h_M:&ved=0CAUQjRw&url=http://www.humpath.com/spip.php?article1617&ei=jWFIUpLZIJCK9AS7ioGIBA&psig=AFQjCNFQzHRO2AVSK6TOZwycdreKykVRkQ&ust=1380561405029459http://www.google.com.ag/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&docid=ZCU7f3mIKF8PjM&tbnid=nFuSZCyeNtkVeM:&ved=0CAUQjRw&url=http://www.webpathology.com/image.asp?case=73&n=1&ei=iWBIUqGzE5Ca9QSc-oHgBg&bvm=bv.53217764,d.eWU&psig=AFQjCNFQzHRO2AVSK6TOZwycdreKykVRkQ&ust=1380561405029459http://www.google.com.ag/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&docid=ZCU7f3mIKF8PjM&tbnid=nFuSZCyeNtkVeM:&ved=0CAUQjRw&url=http://www.webpathology.com/image.asp?case=73&n=1&ei=iWBIUqGzE5Ca9QSc-oHgBg&bvm=bv.53217764,d.eWU&psig=AFQjCNFQzHRO2AVSK6TOZwycdreKykVRkQ&ust=1380561405029459http://www.google.com.ag/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&docid=ZCU7f3mIKF8PjM&tbnid=nFuSZCyeNtkVeM:&ved=0CAUQjRw&url=http://www.webpathology.com/image.asp?case=73&n=1&ei=iWBIUqGzE5Ca9QSc-oHgBg&bvm=bv.53217764,d.eWU&psig=AFQjCNFQzHRO2AVSK6TOZwycdreKykVRkQ&ust=1380561405029459


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Describe the

morphology seenhere.

What is your diagnosis?

Wilms tumor/Nephroblastoma
http://www.google.com.ag/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=oNu9rR_C7SLulM&tbnid=zsM7wiYCc_2h_M:&ved=0CAUQjRw&url=http://www.humpath.com/spip.php?article1617&ei=jWFIUpLZIJCK9AS7ioGIBA&psig=AFQjCNFQzHRO2AVSK6TOZwycdreKykVRkQ&ust=1380561405029459http://www.google.com.ag/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&docid=ZCU7f3mIKF8PjM&tbnid=nFuSZCyeNtkVeM:&ved=0CAUQjRw&url=http://www.webpathology.com/image.asp?case=73&n=1&ei=iWBIUqGzE5Ca9QSc-oHgBg&bvm=bv.53217764,d.eWU&psig=AFQjCNFQzHRO2AVSK6TOZwycdreKykVRkQ&ust=1380561405029459http://www.google.com.ag/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&docid=ZCU7f3mIKF8PjM&tbnid=nFuSZCyeNtkVeM:&ved=0CAUQjRw&url=http://www.webpathology.com/image.asp?case=73&n=1&ei=iWBIUqGzE5Ca9QSc-oHgBg&bvm=bv.53217764,d.eWU&psig=AFQjCNFQzHRO2AVSK6TOZwycdreKykVRkQ&ust=1380561405029459http://www.google.com.ag/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&docid=ZCU7f3mIKF8PjM&tbnid=nFuSZCyeNtkVeM:&ved=0CAUQjRw&url=http://www.webpathology.com/image.asp?case=73&n=1&ei=iWBIUqGzE5Ca9QSc-oHgBg&bvm=bv.53217764,d.eWU&psig=AFQjCNFQzHRO2AVSK6TOZwycdreKykVRkQ&ust=1380561405029459


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Thank you !
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