Lab 1 Case Summaries

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Lab 1Case Summaries

• M2 Renal Pathology Lab

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Lab 1 Case 1

• A 7-year-old boy in primary school has come to
  see his pediatrician. He says that he recently
  had an upper respiratory infection, but that it
  has passed. His chief complaint today is that he
  feels tired and lacks the energy to play his
  favorite sport Guitar Hero. Asked if there was
  anything else bothering him, he took the
  opportunity to complain about his little sister
  whom he suspected of putting laundry detergent in
  the toilet bowl, because after urinating he has
  recently noticed a lot of frothiness in the bowl.
  He has no significant prior medical history. On
  physical exam his pediatrician notices that he
  has mild edema around his ankles and in his
  lumbosacral region. His BP is 100/60 mmHg. The
  physical examination is completed and lab studies
  are ordered.

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Minimal Change Disease
5 important points
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Lab 1 Case 2

• A 63 year old man with multiple myeloma (a
  malignant plasma cell neoplasm) sees his
  oncologist with a complaint of puffiness around
  his eyes, and swollen ankles and feet that make
  it difficult to put his shoes on. On physical
  exam his oncologist confirms pitting edema of
  both ankles and a palpable liver 2.0 cm below the
  costal margin. His BP is 120/70 mmHg. The
  physical examination is completed and lab studies
  are ordered.

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Renal Amyloidosis
5 important points
Congo Red stain
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Lab 1 Case 3

• A 63 year old man was seen by his primary care
  physician for edema of the ankles and feet of
  about 6 weeks duration. He has been diabetic for
  about 12 years and manages his own daily insulin
  regimen. He has a history of alcoholism and
  intravenous drug abuse, and indicates that he has
  not abused either for the last 10 years. He said
  that heart trouble ran in his family, and that
  his mother was diabetic also. On physical exam,
  his physician noted 4 pitting edema of the
  ankles and feet. Crusted ulcerations were present
  on the soles of his feet. A fundoscopic exam
  showed many microaneurysms bilaterally. His BP
  was 160/110 mmHg.

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Diabetic Glomerulosclerosis
5 important points
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Lab 1 Case 4

• A 31 year old woman whose job has recently
  relocated her to a new city sees her new primary
  care physician for dysuria and mild flank pain.
  She reports that she has noticed increasing
  polyuria and nocturia over the last year or so.
  She has been treated for kidney infections before
  but no real workup of the cause for these was
  ever undertaken. Her back pain has been present
  off and on for a couple of years she takes
  NSAIDs as necessary to relieve her discomfort.
  She remembers having bladder surgery as a small
  child, but does not know the exact nature of the
  procedure or condition. On physical exam her BP
  is 150/100 mmHg.

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Chronic Pyelonephritis
5 important points
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Lab 1 Case 5

• An 11 year old boy in elementary school has come
  to his pediatrician with a complaint of
  hematuria. He had noticed this event once before,
  but it had cleared up on its own. But it now it
  has returned, so he decided to tell his parents
  who brought him in today. He remembers having a
  bad sore throat during the summer, but did not
  mention this to his parents because he did not
  want them to keep him from going to the swimming
  pool with his friends. On physical exam he is a
  normally developed boy without evidence of rash
  or current respiratory infection. His BP is
  100/60 mmHg.

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IgA Nephropathy
IF anti-IgA mesangial
5 important points
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Lab 1 Case 6

• A 14 year old high school field hockey player
  sees her family doctor complaining of weakness,
  and lethargy. She said that about 5 weeks ago she
  had a cough and sore throat, but that it had long
  since cleared up. But she now notices that her
  urine output is really low these last two days.
  On physical exam, her doctor notices some mild
  edema about her ankles and eyes. Her BP is 110/65
  mmHg.

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Acute Poststreptococcal Glomerulonephritis
5 important points
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Key Lecture and Lab Self Assessment 1

• 10/7/2009

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Challenge 1

• What are 2 features of the nephrotic syndrome?
• gt3.5 grams proteinuria
• Hypoalbuminemia
• Hyperlipidemia
• Lipiduria
• What are 2 features of the nephritic syndrome?
• Hematuria
• Azotemia
• Proteinuria, variable, but mostly less than
  nephrotic range
• Oliguria
• Edema
• Hypertension

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Challenge 2

• Other than minimal change disease, what are 2
  conditions that may cause the nephrotic syndrome?
• Focal segmental glomerulosclerosis
• Membranous glomerulonephropathy
• Membranoproliferative glomerulonephritis
  (nephrotic or nephritic)
• Diabetic glomerulopathy
• IgA nephropathy (nephrotic or nephritic)
• Renal amyloidosis

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Challenge 3

• Which compartment is most seriously affected in
  chronic pyelonephritis?
• Glomerular
• Vascular
• Tubulointerstitial
• Name one mechanism that may lead to the changes
  of chronic pyelonephritis.
• 1) Vesicoureteral reflux complicated by urinary
  infection
• 2) Chronic obstruction complicated by infection

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Challenge 4

• Can you recognize IgA nephropathy by light
  microscopy alone?
• no
• What finding is necessary to diagnose IgA
  nephropathy?
• IgA as the brightest or co-brightest
  immunofluorescent signal in the mesangium

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Challenge 5

• Can IgA nephropathy recur post-transplant?
• yes
• Can focal segmental glomerulosclerosis recur
  post-transplant?
• yes
• Can diabetic glomerulosclerosis recur
  post-transpant?
• yes

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Challenge 6

• Where are the deposits of acute poststreptococcal
  glomerulonephritis (APSGN) located?
• subepithelial
• Which has the larger deposits
• APSGN
• Membranous glomerulonephropathy

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APSGN vs MGN
Use the GBM as the reference point for size
compared to the GBM, deposits (D) on the right
(APSGN) are much larger than those on the left
(MGN)!
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Challenge 7

• What accounts for the tea-colored urine of ASPGN?
• Blood in the urine - hematuria

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Challenge 8

• Which is more common?
• Diabetic glomerulonephropathy
• IgA nephropathy
• Minimal change disease

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End