CASE 3 AN UNUSUAL CASE OF NEPHROTIC SYNDROME
|
|
- Clifford Hodge
- 5 years ago
- Views:
Transcription
1 CASE 3 AN UNUSUAL CASE OF NEPHROTIC SYNDROME Dr Seethalekshmy N.V., Dr.Annie Jojo, Dr Hiran K.R., Amrita institute of Medical Sciences, Kochi, Kerala
2 Case history 34 year old gentleman Nephrotic range proteinuria 1 year ago Treated with steroids and endoxan for a short duration. Renal functions been gradually and steadily deteriorating. No h/o diabetes mellitus/ hypertension. Physical examination revealed moderately built man, uremic with dry skin. BP- 150/90mmHg. USS :Bulky kidneys with preserved CMD, No organomegaly.
3 Investigations Hb 7gm TC /cmm Urine sugar- Trace, Urine Albumin +++, Microscopy: Pus Cells 8-10/ HPF, RBC0-1/ HPF, Epithelial cells OCC/ HPF S.creatinine 7.5mg/dl 24hr urine volume : 1750mg/dl 24hr urine protein : 5040mg
4 Investigations Urine Bence jones protein -Negative Serum electrophoresis : Normal electrophoretic pattern with reduced albumin ( ). No abnormal band Bone marrow No plasmacytosis Renal biopsy done
5 H&Ex100
6 CME on Renal Pathology by ISRTP in collaboration with Indian Society of Nephrology H&Ex100, 12th December 2007, New Delhi
7 H&Ex400
8 H&Ex400
9 PASx100
10 PASx400
11 Silver x400
12 MT x400
13 Congo red x400
14 IHC kappax400
15 IHC-lambdax400
16 Special stain :Nodules are negative for congo red stain,nonpolarising Immunoflulorescence studies: The glomeruli are negative for IgG, IgA, IgM, C3 and C1q. Immunohistochemistry Nodules in glomeruli showed kappa light chain restriction
17 Diagnosis : Renal Biopsy: LIGHT CHAIN DEPOSITION DISEASE FOLLOW UP Started of hemodialysis, proteinuria persisted, repeat bone marrow evaluation on 22/1/07 (after 2 months of initial biopsy)showed 42% plasma cells with kappa light chain restriction
18 Algorithm for evaluation of organized deposits in kidney CONGO RED STAIN Positive Negative Amyloid Non-amyloid +ve Ig derived Immunofluorescence -ve Non-Ig derived eg DM Cryoglobulinemia Monoclonal gammopathy SLE Immunotactoid - CLL -Benign glomerulopathy - Mixed essential -CLL - Multiple myeloma -LCDD -Multiple myeloma
19 Special stains in nodular glomerular lesions LESIONS PAS PAS/ JONES MASSON Trichrome CONGO RED IMMUNOTACT OID +++ Neg Blue Neg DM +++ Black Blue Neg LIGHT/HEAVY CHAIN ++ Neg Blue Neg AMYLOID Neg Neg Blue +++ FIBRONECTIN ++ Neg Red Neg COLLAGEN Neg Neg Blue Neg.
20 LCDD Light chain deposition disease ( LCDD) is the deposition of monoclonal, amorphous, noncongophilic light chains in multiple organs that do not exhibit a fibrillar structure when examined ultrastructurally.
21 LCDD-BIOLOGY OF DISEASE Uncommon complication of multiple myeloma / other plasma cell dyscrasias Occurs in 5% of cases of myeloma. 1/3rd of patients do not fulfill the diagnostic criteria of myeloma at the time of diagnosis. Kappa to lambda ratio is approximately 4:1. In 1976, Randall et al recognized LCDD as an infiltration of light chains involving multiple organs. Renal disease usually dominates Deposition found in the heart, liver, lungs, endocrine glands, skin and other organs.
22 CLINICAL FEATURES Mean age 57 yrs M/F ratio of 4:1 Many patients have heavy proteinurias +/- haematuria. Proteinuria is usually non selective. Progressive renal failure Prognosis of patients with LCDD is generally poor Death - attributed to cardiac disease, heart failure, or infectious complications.
23 Discussion Glomerulopathic LCs have been reported to play pivotal roles in the pathogenesis of LC-mediated glomerulopathies. Interaction of these LCs with mesangial cells initiates a receptor-mediated process which then controls downstream events. Based on the type and degree of structurally abnormal LC, processes such as endocytosis, activation of growth factors and cytokines, and mesangial matrix alterations are regulated. Two distinct glomerulopathies have been described with different pathogeneses. However, damage to the glomerulus is a sequel shared by both(alamyloidosis and LCDD), which if left uncontrolled eventually results in renal failure. Herrera GA (ed): The Kidney in Plasma Cell Dyscrasias. Contrib Nephrol. Basel, Karger, 2007, vol 153, pp
24 Unstimulated mesangial cells c-fos LCs c-fos c-fos Mesangial cells incubated with G-LCs c-fos Am-Lc PDGF- β LCDD-LC TGF- β TGF- β Schematic representation of early events that occur when mesangial cells are exposed to different types of glomerulopathic LCs. Upon incubation of mesangial cells with glomerulopathic LCs, c-fos changes its normal cytoplasmic to a nuclear location. c-fos, through the action of PDGF-β controls cell proliferation and is also responsible for cell surface changes (ruffling) and rounding-up of mesangial cells. PDGF-β is activated in both conditions (AL-amyloidosis and LCDD). TGF-β is increased in LCDD and decreased in AL-amyloidosis.
25 Keeling J et al.: AL-Amyloidosis and Light-Chain Deposition Disease Light Chains Induce Divergent PhenotypicTransformations of Human Mesangial Cells. Lab Invest 84: , 2004.
26 Treatment High-dosage chemotherapy with blood stem cell transplantation (LCDD and overt myeloma) Conventional chemotherapy including high-dosage dexamethasone (older than 70 yr) As in AL-amyloidosis, monitoring of LC production should rely on free LC assay, particularly in patients without a blood and urine monoclonal component Kidney transplantation should not be an option for patients with LCDD unless measures have been taken to reduce LC production Future pathophysiology-driven therapeuticdirections include 1.Blocking of LC binding to mesangial receptors, 2.Use of TGF- antagonists, 3.Inhibitors of LC-induced signaling pathways. Clin J Am Soc Nephrol 1: , 2006
27 References 1. Herrera GA (ed): The Kidney in Plasma Cell Dyscrasias.Contrib Nephrol. Basel, Karger, 2007, vol 153, pp Pierre Ronco, Emmanuelle Plaisier, Be atrice Mougenot: Immunoglobulin Light (Heavy)-Chain Deposition Disease: From Molecular Medicine to Pathophysiology-Driven Therapy,Clin J Am Soc Nephrol 1: , Keeling J, Teng J, Herrera GA: AL-amyloidosis and light chain deposition disease -light chains induce divergent phenotypic transformations of human mesangial cells. Lab Invest 84: , David J. Salant, Vaishali Sanchorawala, and Vivette D. D Agati A Case of Atypical Light Chain Deposition Disease Diagnosis and Treatment, Clin J Am Soc Nephrol 2: , Hepstinstall s Pathology of kidney 6 th ed (lippincot-raven)
Interesting case seminar: Native kidneys Case Report:
Interesting case seminar: Native kidneys Case Report: Proximal tubulopathy and light chain deposition disease presented as severe pulmonary hypertension with right-sided cardiac dysfunction and nephrotic
More informationCASE 4 A RARE CASE OF INTRALUMINAL GLOMERULAR CAPILLARY DEPOSITS
CASE 4 A RARE CASE OF INTRALUMINAL GLOMERULAR CAPILLARY DEPOSITS DR ANNIE JOJO, Dr Seethalekshmy N V, Dr Nanda Kachare DEPARTMENT OF PATHOLOGY, AMRITA INSTITUTE OF MEDICAL SCIENCES, KOCHI. 54 yrs female,
More informationFIBRILLARY GLOMERULONEPHRITIS DIAGNOSTIC CRITERIA, PITFALLS, AND DIFFERENTIAL DIAGNOSIS
FIBRILLARY GLOMERULONEPHRITIS DIAGNOSTIC CRITERIA, PITFALLS, AND DIFFERENTIAL DIAGNOSIS Guillermo A. Herrera MD Louisiana State University, Shreveport Fibrils in bundles 10-20 nm d Diabetic fibrillosis
More informationExpanding Spectrum of Diseases Associated with Plasma Cell Dyscrasias
Expanding Spectrum of Diseases Associated with Plasma Cell Dyscrasias Eva Honsova Institute for Clinical and Experimental Medicine Prague, Czech Republic eva.honsova@ikem.cz Plasma cell dyscrasias Plasma
More informationGlomerular diseases with organized deposits
Glomerular diseases with organized deposits Banu Sis, MD, FRCPC University of Alberta, Edmonton, AB, Canada Ulusal Patoloji Kongresi, Manavgat, Antalya 8/11/2012 What is an organized deposit? A number
More informationMonoclonal Gammopathies and the Kidney. Tibor Nádasdy, MD The Ohio State University, Columbus, OH
Monoclonal Gammopathies and the Kidney Tibor Nádasdy, MD The Ohio State University, Columbus, OH Monoclonal gammopathy of renal significance (MGRS) Biopsies at OSU (n=475) between 2007 and 2016 AL or AH
More informationSheena Surindran Grand Rounds 2/15/11
Sheena Surindran Grand Rounds 2/15/11 Affects 5 12 person per million / year 5 10% associated with myeloma Median survival without treatment is 12 40 months Most commonly affected organs are kidney, heart
More informationTarek ElBaz, MD. Prof. Internal Medicine Chief, Division of Renal Medicine Al Azhar University President, ESNT
The Kidney in Multiple Myeloma Tarek ElBaz, MD. Prof. Internal Medicine Chief, Division of Renal Medicine Al Azhar University President, ESNT Normal Cell Plasma cells produce antibodies that bind to antigens,
More informationOrdering Physician. Collected REVISED REPORT. Performed. IgG IF, Renal MCR. Lambda IF, Renal MCR. C1q IF, Renal. MCR Albumin IF, Renal MCR
RenalPath Level IV Wet Ts IgA I Renal IgM I Renal Kappa I Renal Renal Bx Electron Microscopy IgG I Renal Lambda I Renal C1q I Renal C3 I Renal Albumin I Renal ibrinogen I Renal Mayo Clinic Dept. of Lab
More informationJo Abraham MD Division of Nephrology University of Utah
Jo Abraham MD Division of Nephrology University of Utah 68 year old male presented 3 weeks ago with a 3 month history of increasing fatigue He reported a 1 week history of increasing dyspnea with a productive
More informationCase Report Nephrotic Syndrome Secondary to Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits of Lambda Light Chain
Hindawi Publishing Corporation Case Reports in Nephrology Volume 214, Article ID 164694, 6 pages http://dx.doi.org/1.1155/214/164694 Case Report Nephrotic Syndrome Secondary to Proliferative Glomerulonephritis
More informationCase Report A Case of Proliferative Glomerulonephritis with Monoclonal IgG Deposits That Showed Predominantly Membranous Features
Hindawi Case Reports in Nephrology Volume 2017, Article ID 1027376, 5 pages https://doi.org/10.1155/2017/1027376 Case Report A Case of Proliferative Glomerulonephritis with Monoclonal IgG Deposits That
More informationCase Presentation Turki Al-Hussain, MD
Case Presentation Turki Al-Hussain, MD Director, Renal Pathology Chapter Saudi Society of Nephrology & Transplantation Consultant Nephropathologist & Urological Pathologist Department of Pathology & Laboratory
More informationA Case of IgG2 Heavy Chain Deposition Disease in a Patient with Kappa Positive Plasma Cell Dyscrasia
Published online: August 14, 2014 2296 9705/14/0051 0006$39.50/0 This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC)
More informationDr Ian Roberts Oxford. Oxford Pathology Course 2010 for FRCPath Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust
Dr Ian Roberts Oxford Oxford Pathology Course 2010 for FRCPath Present the basic diagnostic features of the commonest conditions causing proteinuria & haematuria Highlight diagnostic pitfalls Nephrotic
More informationGlomerular pathology in systemic disease
Glomerular pathology in systemic disease Lecture outline Lupus nephritis Diabetic nephropathy Glomerulonephritis Associated with Bacterial Endocarditis and Other Systemic Infections Henoch-Schonlein Purpura
More informationGlomerular Pathology- 1 Nephrotic Syndrome. Dr. Nisreen Abu Shahin
Glomerular Pathology- 1 Nephrotic Syndrome Dr. Nisreen Abu Shahin The Nephrotic Syndrome a clinical complex resulting from glomerular disease & includes the following: (1) massive proteinuria (3.5 gm /day
More informationMultiple Myeloma Advances for clinical pathologists & histopathologists
Multiple Myeloma Advances for clinical pathologists & histopathologists CME in Haematology 2014 IAPP & Dept of Pathology, BVDUMC, Pune Sunday, 4 th May 2014 Dr. M.B. Agarwal, MD, MNAMS Head, Dept of Haematology
More informationPathology of Complement Mediated Renal Disease
Pathology of Complement Mediated Renal Disease Mariam Priya Alexander, MD Associate Professor of Pathology GN Symposium Hong Kong Society of Nephrology July 8 th, 2017 2017 MFMER slide-1 The complement
More informationRENAL HISTOPATHOLOGY
RENAL HISTOPATHOLOGY Peter McCue, M.D. Department of Pathology, Anatomy & Cell Biology Sidney Kimmel Medical College There are no conflicts of interest. 1 Goals and Objectives! Goals Provide introduction
More informationHistopathology: Glomerulonephritis and other renal pathology
Histopathology: Glomerulonephritis and other renal pathology These presentations are to help you identify basic histopathological features. They do not contain the additional factual information that you
More informationLaboratory Examination
Todd Zimmerman, M.D. 64 year old African American male presents to establish care with PCG. Meds: Norvasc 5 mg daily PMHx: HTN x 20 years, poorly controlled SHx: No tobacco, illicit; rare EtOH ROS: Negative
More informationLIGHT CHAIN DISEASE B. DHANALAKSHMI 1 & V. HEMAVATHY 2
TJPRC: International Journal of Nursing and Patient Safety & Care (TJPRC: IJNPSC) Vol. 1, Issue 1, Dec 2016, 21-24 TJPRC Pvt. Ltd. LIGHT CHAIN DISEASE B. DHANALAKSHMI 1 & V. HEMAVATHY 2 1 Associate Professor,
More informationC1q nephropathy the Diverse Disease
C1q nephropathy the Diverse Disease Danica Galešić Ljubanović School of Medicine, University of Zagreb Dubrava University Hospital Zagreb, Croatia Definition Dominant or codominant ( 2+), mesangial staining
More informationLec-14 د.خالد نافع. Medicine. Multiple Myeloma
Fifth stage Lec-14 د.خالد نافع Medicine 24/4/2016 Multiple Myeloma Plasma cell myeloma Variants Non - secretory myeloma Indolent myeloma Smouldering myeloma Plasma cell leukaemia Plasmacytoma - Solitary
More informationRenal Pathology 1: Glomerulus. With many thanks to Elizabeth Angus PhD for EM photographs
Renal Pathology 1: Glomerulus With many thanks to Elizabeth Angus PhD for EM photographs Anatomy of the Kidney http://www.yalemedicalgroup.org/stw/page.asp?pageid=stw028980 The Nephron http://www.beltina.org/health-dictionary/nephron-function-kidney-definition.html
More informationMayo Clinic/ RPS Consensus Report on Classification, Diagnosis, and Reporting of Glomerulonephritis
Mayo Clinic/ RPS Consensus Report on Classification, Diagnosis, and Reporting of Glomerulonephritis Sanjeev Sethi, MD, PhD Department of Laboratory Medicine and Pathology Disclosure Relevant Financial
More informationCase 3. ACCME/Disclosure. Laboratory results. Clinical history 4/13/2016
Case 3 Lynn D. Cornell, M.D. Mayo Clinic, Rochester, MN Cornell.Lynn@mayo.edu USCAP Renal Case Conference March 13, 2016 ACCME/Disclosure Dr. Cornell has nothing to disclose Clinical history 57-year-old
More informationSurgical Pathology Report
Louisiana State University Health Sciences Center Department of Pathology Shreveport, Louisiana Accession #: Collected: Received: Reported: 6/1/2012 09:18 6/2/2012 09:02 6/2/2012 Patient Name: Med. Rec.
More informationDr Ian Roberts Oxford. Oxford Pathology Course 2010 for FRCPath Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust
Dr Ian Roberts Oxford Oxford Pathology Course 2010 for FRCPath Plan of attack: Diagnostic approach to the renal biopsy Differential diagnosis of the clinical syndromes of renal disease Microscopy Step
More informationM-Protien, what to do next? Ismail A Sharif MD, FRCPc Internal Medicine Day 22 nd April 2016
+ M-Protien, what to do next? Ismail A Sharif MD, FRCPc Internal Medicine Day 22 nd April 2016 + Disclosures Advisory Boards: AMGEN, Lundbeck, NOVARTIS + Subtypes of Plasma Cell Disorders Increased Plasma
More informationCase Presentation Turki Al-Hussain, MD
Case Presentation Turki Al-Hussain, MD Director, Renal Pathology Chapter Saudi Society of Nephrology & Transplantation Consultant Nephropathologist & Urological Pathologist Department of Pathology & Laboratory
More informationForms Revision: Myeloma Changes
Sharing knowledge. Sharing hope. Forms Revision: Myeloma Changes J. Brunner, PA-C and A. Dispenzieri, MD February 2013 Disclosures Janet Brunner, PA-C I have no relevant conflicts of interest to disclose.
More informationsubstance staining with IgG, C3 and IgA (trace) Linear deposition of IgG(+), IgA.M(trace) and C3(+++) at the DEJ
Direct Immunofluorescence: Skin Diagnosis Findings Picture Pemphigus Vulgaris and it s Intracellular cement variants substance staining with IgG, C3 and IgA (trace) Bullous Pemphigoid and it s variants
More informationMonoclonal gammopathies consist of. Monoclonal GammopathyeAssociated Proliferative Glomerulonephritis REVIEW
REVIEW Monoclonal GammopathyeAssociated Proliferative Glomerulonephritis Sanjeev Sethi, MD, PhD, and S. Vincent Rajkumar, MD Abstract Monoclonal gammopathy is characterized by circulating monoclonal immunoglobulin
More informationLight-Chain Mediated Acute Tubular Interstitial Nephritis. A Poorly Recognized Pattern of Renal Disease in Patients With Plasma Cell Dyscrasia
Light-Chain Mediated Acute Tubular Interstitial Nephritis A Poorly Recognized Pattern of Renal Disease in Patients With Plasma Cell Dyscrasia Xin Gu, MD; Guillermo A. Herrera, MD Context. Acute renal failure
More informationDiabetic Nephropathy
Diabetic Nephropathy Objectives: Know what Diabetic Nephropathy means. Know how common is Diabetic nephropathy in Saudi Arabia and to appreciate how bad are this complications. Know the risk factors of
More informationA case of heavy chain deposition disease complicated by acquired angioedema.
Case Report http://www.alliedacademies.org/pathology-and-disease-biology/ A case of heavy chain deposition disease complicated by acquired angioedema. Rafia Chaudhry 1 *, Gautam Bhave 2, Rachel Fissell
More informationOsteosclerotic Myeloma (POEMS Syndrome)
Osteosclerotic Myeloma (POEMS Syndrome) Osteosclerotic Myeloma (POEMS Syndrome) Synonyms Crow-Fukase syndrome Multicentric Castleman disease Takatsuki syndrome Acronym coined by Bardwick POEMS Scheinker,
More informationMultiple intra-renal pathological injury patterns in resistant myeloma
Multiple intra-renal pathological injury patterns in resistant myeloma Dharshan Rangaswamy 1, Mohit Madken 1, Mahesha Vankalakunti 2, Ravindra Prabhu Attur 1, and Shankar Prasad Nagaraju 1 1. Department
More informationTHE URINARY SYSTEM. The cases we will cover are:
THE URINARY SYSTEM The focus of this week s lab will be pathology of the urinary system. Diseases of the kidney can be broken down into diseases that affect the glomeruli, tubules, interstitium, and blood
More informationTHE URINARY SYSTEM. The cases we will cover are:
THE URINARY SYSTEM The focus of this week s lab will be pathology of the urinary system. Diseases of the kidney can be broken down into diseases that affect the glomeruli, tubules, interstitium, and blood
More informationLab 3, case 1. Is this an example of nephrotic or nephritic syndrome? Why? Which portion of the nephron would you expect to be abnormal?
Lab 3, case 1 12-year-old Costa Rican boy is brought into clinic by his parents because of dark brownish-red urine over the last 24 hours. The family has been visiting friends in Indianapolis for two weeks.
More informationGlomerular diseases mostly presenting with Nephritic syndrome
Glomerular diseases mostly presenting with Nephritic syndrome 1 The Nephritic Syndrome Pathogenesis: proliferation of the cells in glomeruli & leukocytic infiltrate Injured capillary walls escape of RBCs
More informationArticle. Laser Microdissection and Proteomic Analysis of Amyloidosis, Cryoglobulinemic GN, Fibrillary GN, and Immunotactoid Glomerulopathy
Article Laser Microdissection and Proteomic Analysis of Amyloidosis, Cryoglobulinemic GN, Fibrillary GN, and Immunotactoid Glomerulopathy Sanjeev Sethi,* Jason D. Theis,* Julie A. Vrana,* Fernando C. Fervenza,
More informationGlomerular pathology-2 Nephritic syndrome. Dr. Nisreen Abu Shahin
Glomerular pathology-2 Nephritic syndrome Dr. Nisreen Abu Shahin 1 The Nephritic Syndrome Pathogenesis: inflammation proliferation of the cells in glomeruli & leukocytic infiltrate Injured capillary walls
More informationAmyloidosis is caused by extracellular deposition of
Mass Spectrometry Based Proteomic Diagnosis of Renal Immunoglobulin Heavy Chain Amyloidosis Sanjeev Sethi,* Jason D. Theis,* Nelson Leung, Angela Dispenzieri,* Samih H. Nasr,* Mary E. Fidler,* Lynn D.
More informationDense deposit disease with steroid pulse therapy
Case Report Dense deposit disease with steroid pulse therapy Jun Odaka, Takahiro Kanai, Takane Ito, Takashi Saito, Jun Aoyagi, and Mariko Y Momoi Abstract Treatment of dense deposit disease DDD has not
More informationClinical history. 73 yo man with chest pain Systemic hypertension and WG Stress EKG N Stress echocardiogram: Cardiac catheterization: no CAD
CASE 8 Clinical history 73 yo man with chest pain Systemic hypertension and WG Stress EKG N Stress echocardiogram: Concentric hypertrophy Hypokinesis of LV-Inf Cardiac catheterization: no CAD Technique
More informationThe Long-term Outcomes after VAD plus SCT Therapy in a Patient with AL Amyloidosis and Severe Factor X Deficiency
doi: 10.2169/internalmedicine.9263-17 http://internmed.jp CASE REPORT The Long-term Outcomes after VAD plus SCT Therapy in a Patient with AL Amyloidosis and Severe Factor X Deficiency Dosuke Iwadate 1,EikoHasegawa
More informationAmyloidosis is a generic term for a group of diseases
Typing of Amyloidosis in Renal Biopsies Diagnostic Pitfalls Anjali A. Satoskar, MD; Kelly Burdge, MD; Daniel J. Cowden, MD; Gyongyi M. Nadasdy, MD; Lee A. Hebert, MD; Tibor Nadasdy, MD Context. Amyloidosis
More informationJournal of Nephropathology
www.nephropathol.com DOI: 10.15171/jnp.2017.36 J Nephropathol. 2017;6(3):220-224 Journal of Nephropathology Proliferative glomerulonephritis with monoclonal IgG deposits; an unusual cause of de novo disease
More informationRENAL EVENING SPECIALTY CONFERENCE
RENAL EVENING SPECIALTY CONFERENCE Harsharan K. Singh, MD The University of North Carolina at Chapel Hill Disclosure of Relevant Financial Relationships No conflicts of interest to disclose. CLINICAL HISTORY
More informationGRAND ROUNDS
GRAND ROUNDS 5.14.13 CASE 64 y.o AAF with h/o HTN, DM, HLD, MGUS referred by PMD for uncontrolled resistant hypertension, new renal failure (Cr of 1.5), hematuria and proteinuria Per patient systolic BP
More informationEnterprise Interest Nothing to declare
Enterprise Interest Nothing to declare Minimal change disease (MCD) related new electron microscopy findings in a patient on Levothyroxine sodium (LT) for hypothyroidism: A case report Dr. Ali Al-Omari
More informationClinicopathological analysis of proliferative glomerulonephritis with monoclonal IgG deposits in 5 renal allografts
Wen et al. BMC Nephrology (2018) 19:173 https://doi.org/10.1186/s12882-018-0969-3 RESEARCH ARTICLE Open Access Clinicopathological analysis of proliferative glomerulonephritis with monoclonal IgG deposits
More informationFocal Segmental Glomerulosclerosis and the Nephro6c Syndrome Dr. A. Gangji Dr. P. Marge>s. Part 1: Clinical
Focal Segmental Glomerulosclerosis and the Nephro6c Syndrome Dr. A. Gangji Dr. P. Marge>s Part 1: Clinical Pa#ent DM 18 year old McMaster student Back pain, severe fa#gue Oct 2006 Leg swelling to ER Nov
More informationAtypical IgA Nephropathy
Atypical IgA Nephropathy Richard J. Glassock, MD, MACP Geffen School of Medicine at UCLA XXXIII Chilean Congress of Nephrology, Hypertension and Transplantation Puerto Varas, Chile October 6, 2016 IgA
More informationOverview of glomerular diseases
Overview of glomerular diseases *Endothelial cells are fenestrated each fenestra: 70-100nm in diameter Contractile, capable of proliferation, makes ECM & releases mediators *Glomerular basement membrane
More informationHematology 101. Rachid Baz, M.D. 5/16/2014
Hematology 101 Rachid Baz, M.D. 5/16/2014 Florida 101 Epidemiology Estimated prevalence 8,000 individuals in U.S (compare with 80,000 MM patients) Annual age adjusted incidence 3-8/million-year 1 More
More informationSWOG ONCOLOGY RESEARCH PROFESSIONAL (ORP) MANUAL RESPONSE ASSESSMENT MYELOMA CHAPTER 11C REVISED: SEPTEMBER 2016
MYELOMA Quantitative Markers-Myeloma Assessment Quantitative markers are biochemicals that are recorded in tests on body fluids such as serum and urine. Applicable Disease Sites The myeloma disease site
More informationLight chain deposition disease presenting with hepatomegaly: an association with amyloid-like fibrils
Postgraduate Medical Journal (1988) 64, 804-808 Light chain deposition disease presenting with hepatomegaly: an association with amyloid-like fibrils G. Pelletier,I M. Fabre,2 P. Attali,i A. Ladouch-Badre,2
More informationComparison of amyloid deposition in human kidney biopsies as predictor of poor patient outcome
Castano et al. BMC Nephrology (2015) 16:64 DOI 10.1186/s12882-015-0046-0 RESEARCH ARTICLE Comparison of amyloid deposition in human kidney biopsies as predictor of poor patient outcome Open Access Ekaterina
More informationPlasma cell myeloma (multiple myeloma)
Plasma cell myeloma (multiple myeloma) Common lymphoid neoplasm, present at old age (70 years average) Remember: plasma cells are terminally differentiated B-lymphocytes that produces antibodies. B-cells
More informationΑνάπτυξη Βιοτράπεζας για την Ανίχνευση Πρώιμων Βιοδεικτών σε Ασθενείς με Χρόνια Νεφρική Νόσο
Ανάπτυξη Βιοτράπεζας για την Ανίχνευση Πρώιμων Βιοδεικτών σε Ασθενείς με Χρόνια Νεφρική Νόσο ΔΗΜΗΤΡΙΟΣ Σ. ΓΟΥΜΕΝΟΣ Νεφρολογικό και Μεταμοσχευτικό Κέντρο Πανεπιστημιακό Νοσοκομείο Πατρών Causes of chronic
More informationAmyloidosis. James J. Stark, MD, FACP Medical Director Cancer Program Maryview Medical Center. Professor of Medicine Eastern Virginia Medical
Amyloidosis James J. Stark, MD, FACP Medical Director Cancer Program Maryview Medical Center Professor of Medicine Eastern Virginia Medical School www.starkoncology.com 68 y.o. man admitted to MMC in March,
More informationCHAPTER 2. Primary Glomerulonephritis
2nd Report of the PRIMARY GLOMERULONEPHRITIS CHAPTER 2 Primary Glomerulonephritis Sunita Bavanandan Lee Han Wei Lim Soo Kun 21 PRIMARY GLOMERULONEPHRITIS 2nd Report of the 2.1 Introduction This chapter
More informationCHAPTER 2 PRIMARY GLOMERULONEPHRITIS
CHAPTER 2 Sunita Bavanandan Lim Soo Kun 19 5th Report of the 2.1: Introduction This chapter covers the main primary glomerulonephritis that were reported to the MRRB from the years 2005-2012. Minimal change
More informationSerum Free Light Chain Assay
Serum Free Light Chain Assay This Infosheet explains what light chains are, what the Serum Free Light Chain Assay is, and why it is used in AL amyloidosis. In AL amyloidosis, abnormal plasma cells in the
More informationCase #1. Robert J. Glinert, M.D. David C. Fisher, M.D. Dana Farber Cancer Institute
Case #1 Robert J. Glinert, M.D. David C. Fisher, M.D. Dana Farber Cancer Institute Patient History Part I 76 year-old man 1997 diagnosed with MGUS (biclonal) during evaluation of (self-limited) anemia.
More informationRECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT. J. H. Helderman,MD,FACP,FAST
RECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT J. H. Helderman,MD,FACP,FAST Vanderbilt University Medical Center Professor of Medicine, Pathology and Immunology Medical Director, Vanderbilt Transplant
More informationMr. I.K 58 years old
Mr. I.K 58 years old Hospitalized because of marked pitting peripheral edema (bilateral crural and perimalleolar edema) and uncontrolled blood pressure (BP 150/100 mmhg under treatment). since age 54 years
More informationFreelite SFLC in CKD why use a different reference range? Dr Colin Hutchison Nephrologist Hawke s Bay DHB
Freelite SFLC in CKD why use a different reference range? Dr Colin Hutchison Nephrologist Hawke s Bay DHB Disclosures I have only really worked with the Freelite assays Previous research funding, technical
More informationHasan Fattah 4/30/2013
Hasan Fattah 4/30/2013 49 yo hispanic male, ho HIV(CD4 229), currently on HAART, course c/b AIDS, Presents with two days ho fever, SOB, blood tinged sputum, and visible hematuria. ROS: no skin rash, joint
More informationYijuan Sun, Amarpreet Sandhu, Darlene Gabaldon, Jonathan Danaraj, Karen S. Servilla, and Antonios H. Tzamaloukas
Case Reports in Nephrology Volume 2012, Article ID 573650, 5 pages doi:10.1155/2012/573650 Case Report Development of Renal Failure without Proteinuria in a Patient with Monoclonal Gammopathy of Undetermined
More informationClinical and pathological characteristics of patients with glomerular diseases at a university teaching hospital: 5-year prospective review
Clinical and pathological characteristics of patients with glomerular diseases at a university teaching hospital: 5-year prospective review KW Chan, TM Chan, IKP Cheng Objective. To examine the prevalence
More informationJon Von Visger 1, Clarissa Cassol 2, Uday Nori 1, Gerardo Franco-Ahumada 1, Tibor Nadasdy 2 and Anjali A. Satoskar 2*
Von Visger et al. BMC Nephrology (2019) 20:53 https://doi.org/10.1186/s12882-019-1239-8 CASE REPORT Open Access Complete biopsy-proven resolution of deposits in recurrent proliferative glomerulonephritis
More informationA Case of Immunotactoid Glomerulopathy with Rapid Progression to End-Stage Renal Disease
Case Study TheScientificWorldJOURNAL (2009) 9, 1348 1354 ISSN 1537-744X; DOI 10.1100/tsw.2009.164 A Case of Immunotactoid Glomerulopathy with Rapid Progression to End-Stage Renal Disease Shikha Jain 1,
More informationClassification of Glomerular Diseases and Defining Individual Glomerular Lesions: Developing International Consensus
Classification of Glomerular Diseases and Defining Individual Glomerular Lesions: Developing International Consensus Mark Haas MD, PhD Department of Pathology & Laboratory Medicine Cedars-Sinai Medical
More informationIKMG Research Group - 4 th International Meeting PROGRAM
IKMG Research Group - 4 th International Meeting PROGRAM SCIENTIFIC & ORGANIZING COMMITTEE ROYAL Virginie, MD - Chair of the 4th IKMG Meeting VENNER Christopher, MD Co-chair of the 4th IKMG Meeting BRIDOUX
More informationApproach to Glomerular Diseases: Clinical Presentation Nephrotic Syndrome Nephritis
GLOMERULONEPHRITIDES Vivette D Agati Jai Radhakrishnan Approach to Glomerular Diseases: Clinical Presentation Nephrotic Syndrome Nephritis Heavy Proteinuria Renal failure Low serum Albumin Hypertension
More informationBurkitt lymphoma. Sporadic Endemic in Africa associated with EBV Translocations involving MYC gene on chromosome 8
Heme 8 Burkitt lymphoma Sporadic Endemic in Africa associated with EBV Translocations involving MYC gene on chromosome 8 Most common is t(8;14) Believed to be the fastest growing tumor in humans!!!! Morphology
More informationYear 2004 Paper one: Questions supplied by Megan
QUESTION 53 Endothelial cell pathology on renal biopsy is most characteristic of which one of the following diagnoses? A. Pre-eclampsia B. Haemolytic uraemic syndrome C. Lupus nephritis D. Immunoglobulin
More informationGlomerulonephritis. Dr Rodney Itaki Anatomical Pathology Discipline.
Glomerulonephritis Dr Rodney Itaki Anatomical Pathology Discipline. University of Papua New Guinea School of Medicine & Health Sciences Division of Pathology Gross anatomy Ref: Goggle Images Microanatomy
More informationElevated Serum Creatinine, a simplified approach
Elevated Serum Creatinine, a simplified approach Primary Care Update Creighton University School of Medicine. April 27 th, 2018 Disclosure Slide I have no disclosures and have no conflicts with this presentation.
More informationCase # 2 3/27/2017. Disclosure of Relevant Financial Relationships. Clinical history. Clinical history. Laboratory findings
Case # 2 Christopher Larsen, MD Arkana Laboratories Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education Committee) in a position to influence or control the content
More informationPost Doctoral Certificate Course (PDCC) in Renal Pathology. Amrita Institute Of Medical Sciences, AIMS, Kochi Department : Pathology
Post Doctoral Certificate Course (PDCC) in Renal Pathology Amrita Institute Of Medical Sciences, AIMS, Kochi Department : Pathology 1 1. Period of Course :One Academic Year 2. No of Candidates: One per
More informationFamilial DDD associated with a gain-of-function mutation in complement C3.
Familial DDD associated with a gain-of-function mutation in complement C3. Santiago Rodríguez de Córdoba, Centro de investigaciones Biológicas, Madrid Valdés Cañedo F. and Vázquez- Martul E., Complejo
More informationTuesday Conference 7/23/2013. Hasan Fattah
Tuesday Conference 7/23/2013 Hasan Fattah 48 AA male, PMH: HTN, proteinuria since 2009, sent from primary clinic for high Cr evaluation (7.1), last known of 1.1 in 2010 associated with sub-nephrotic range
More informationHematology Case Conference 8/5/03
Hematology Case Conference 8/5/03 Bone Marrow Case Patient: Emmxxx Lylexxx 74 year old AA female S/P craniotomy for SDH. Pt has Hx of HTN, DM, Crohn s disease, (R) nephrectomy. Bone marrow for abnormal
More informationUnderstanding the Serum Free Light Chain Assays. Anne L Sherwood, PhD Director of Scientific Affairs The Binding Site, Inc.
Understanding the Serum Free Light Chain Assays Anne L Sherwood, PhD Director of Scientific Affairs The Binding Site, Inc. AL Amyloidosis: abnormality of proteins from Plasma Cells in the Bone Marrow Red
More informationSerum Levels of Free Light Chain before and after Chemotherapy in Primary Systemic AL Amyloidosis
ORIGINAL ARTICLE Serum Levels of Free Light Chain before and after Chemotherapy in Primary Systemic AL Amyloidosis Masayuki MATSUDA, Toshiyuki YAMADA**, Takahisa GONO, Yasuhiro SHIMOJIMA, Wataru ISHII,
More informationDiabetic Nephropathy. Introduction/Clinical Setting. Pathologic Findings Light Microscopy. J. Charles Jennette
12 Diabetic Nephropathy J. Charles Jennette Introduction/Clinical Setting Diabetic nephropathy is a clinical syndrome in a patient with diabetes mellitus that is characterized by persistent albuminuria,
More informationFavorable effect of bortezomib in dense deposit disease associated with monoclonal gammopathy: a case report
Hirashio et al. BMC Nephrology (2018) 19:108 https://doi.org/10.1186/s12882-018-0905-6 CASE REPORT Open Access Favorable effect of bortezomib in dense deposit disease associated with monoclonal gammopathy:
More informationAnaemias and other Pesky Haematology Questions
Anaemias and other Pesky Haematology Questions 3 main topics How do I work out an anaemia.. That oh too common paraprotein patient. Those mildly raised lymphocyte count GP discussed patient with me over
More informationOriginal. IgAN. Key words : IgA nephropathy, IgM deposition, proteinuria, tonsillectomy, steroid pulse therapy. Introduction
Showa Univ J Med Sci 27 3, 167 174, September 2015 Original Prominent IgM Deposition in Glomerulus Is Associated with Severe Proteinuria and Reduced after Combined Treatment of Tonsillectomy with Steroid
More informationSouthern Derbyshire Shared Care Pathology Guidelines. MGUS (Monoclonal Gammopathy of Undetermined Significance)
Southern Derbyshire Shared Care Pathology Guidelines MGUS (Monoclonal Gammopathy of Undetermined Significance) Purpose of guideline This guideline provides information about the risk stratification of
More informationMichael Joffe ST6 Haematology SpR
Michael Joffe ST6 Haematology SpR Mrs SB 71 year old female on AMU Telephone referral to haematology by medicine with Hb 102 MCV 89, normal B12, Folate, Ferritin. PMH DM General decline over several weeks
More informationDiabetic Nephropathy in Spontaneously Diabetic Torii (SDT) Rats
The Open Diabetes Journal, 2011, 4, 45-49 45 Diabetic Nephropathy in Spontaneously Diabetic Torii (SDT) Rats Takeshi Ohta * and Tomohiko Sasase Open Access Biological/Pharmacological Research Laboratories,
More informationInstructions for Plasma Cell Disorders (PCD) Post-HCT Data (Form 2116 Revision 3)
(Form 2116 Revision 3) This section of the CIBMTR Forms Instruction Manual is intended to be a resource for completing the Plasma Cell Disorders (PCD) Post-HCT Data Form. E-mail comments regarding the
More information