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. #: DOB: Gender: Location: Billing #: Payne, Kidnee ARS-22222222 2/30/1943 (Age: 69) M ARS Accurate Reliable Services Ordering Physician: Dr. Quality Care Specimen(s) Received Kidney, biopsy Clinical Diagnosis/History Sixty-nine year old male with proteinuria and microscopic hematuria. Patient presented for evaluation of proteinuria. He was found to have a serum creatinine= 1.31 mg/dl and an estimated glomerular filtration raate= 50 cc / minute. Patient also has microalbuminuria and hyperlipidemia. Interpretation Renal biopsy, left: IgA nephropathy, mesangial proliferative variant, associated with focal mild to moderate interstitial fibrosis and focal, mild to moderate vascular sclerosis. Diagnosis personally rendered by: Xin Gu, M.D. Electronically Signed for Xin Gu, M.D. Guillermo A. Herrera, M.D. Microscopic 6/2/2012 GAH:xx The specimen consists of cortex and medulla. At least sixteen glomeruli are identified in the specimen submitted for light microscopic evaluation. At least two of these glomeruli are globally sclerosed and an additional glomerulus exhibits a segmental area with sclerosis / hyalinosis attached to Bowman s capsule. The viable glomeruli and the nonaffected portions of the segmentally altered glomeruli show thin and regular peripheral capillary walls and variably expanded mesangial areas associated segmentally with increased matrix and a variable increase in cellularity. Trichrome stain shows mild to focally mild to moderate interstitial fibrosis associated with tubular atrophy and drop out. The scattered and inflammatory cells are seen in the interstitium. No active tubulitis is present. Red blood cells are present within tubular lumina. Thickening of some tubular basement membranes is additionally noted. Some hyalin and tubular casts are present, some in slightly dilated tubules. There are red blood cells in tubular lumina, as well as a few red blood cell casts, predominately in the medulla. There is mild to moderate thickening of the walls of some arterioles and small sized arteries. Intimal fibrous thickening is identified in larger vessels. IMMUNOFLUORESCENCE / Page 1 of 5
At least twenty glomeruli are identified in the specimen submitted for immunofluorescence studies. One of these glomeruli is globally sclerosed. There is diffuse and generalized granular mesangial staining for IgA (2+) IgG (2+) C3 (2+), kappa (2+) and lambda light chains (2+). No specific glomerular staining is identified for albumin, fibrinogen, C1q, or IgM. There is staining of few tubular casts for both light chains, IgM, and IgA. No other specific tubular interstitial staining is present for any of the other above mentioned immunoreactants. Furthermore, there is no specific vascular staining for any of the above mentioned immunoreactants. ELECTRON MICROSCOPY Three glomeruli are identified in the thick sections prepared for ultrastructural survey and they are retained in the thin sections. Electron microscopy shows segmental effacement of the foot processes of the basal epithelial cells. There are no immune complexes noted along the peripheral capillary walls. Glomerular basement membranes are unremarkable. The mesangial areas are variably expanded and contain variable numbers of well defined immune complexes. Interstitial fibrosis is seen. No immune complexes are present along the tubular basement membranes. There are red blood cells in some tubular lumina. LEGENDS FOR FIGURES: Row 1- PAS, right and left- Segmental mesangial expansion with hypercellularity. Row 2- Left- trichrome- Interstitial fibrosis. H&E- Segmental glomerulosclerosis. Row 3- Left- H&E- Intimal fibrous thickening. Right- IF,IgA- Mesangial staining. Row 4- Left- IF, lambda: Mesangial staining. IF, C3- Mesangial staining. Row 5- Left- EM- Mesangial expansion. Right- Interstitial fibrosis. Red blood cells in tubular lumen. Row 6- EM- Mesangial expansion with scattered immune complexes. Row 7- EM- Mesangial immune complexes. _001 _002 / Page 2 of 5
_003 _004 _006 _007 _008 _009 PO Box 33932, Shreveport, LA 71130-3932 / Phone (318) 675-7677 Page 3 of 5
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_013 Gross 11/30/2012 XX/GAH:xx Received from Accurate Reliable Services in Qualityville, State are three vials labeled with the patient s name, Kidnee Payne. The vial with Michel s fixative contains several pieces of tissue ranging from 0.3 to 1.3 cm in length. This tissue is submitted in its entirety for immunofluorescence. The vial with formalin fixative contains three pieces of tissue ranging from 0.5 to 1.5 cm in length. This tissue is submitted in its entirety for light microscopy. The vial with glutaraldehyde contains several pieces of tissue ranging from 0.4 to 1.5 cm in length. This tissue is submitted in its entirety for electron microscopy. Billing Data: 1: 88305, 88313, 88313, 88313, 88346(9), 88348 / Page 5 of 5