Histopatologi ved glomerulær sykdom Flashcards
Hva er vanlige kliniske presentasjoner ved glomerulonefritt?
Når bør man gjøre en nyrebiopsi?
Hva er kontraindikasjoner for nyrebiopsi?
Hvordan skal man forholde seg til antikoagulasjon ved en nyrebiopsi?
Hvilke teknikker bruker man ved evaluering av nyrebiopsier?
66 yr old female
Medical history:
- KOLS
- Hypertension
- NSTEMI and PCI of CX -13.
Dec -19:
Last 6 months frequent pulmonary infections, fatigue, sinusitis, night sweating.
GP found creatinine 124 and positive PR3 ANCA.
Admitted 2 weeks later 040119.
Creatinine 285, eGFR 14 ml/min, dip stick: P 4+, B 4+. ACR 95.7 mg/mmol
Urine analysis: Hyaline, granular and wax casts
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Case 1
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Case 1
Case 1
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Case 1
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Case 1
Hva var funnene på snittene i case 1?
Hvilken behandling gir man til pas. i case 1?
Hva viser immunofluorecensen?
Hva var diagnosen ved case 1?
Goodpasture’s syndrome is a triad of alveolar hemorrhage, Glomerulonephritis and circulating anti Glomerular basement membrane antibodies, 25% of cases test positive for ANCA antibodies, this association is known as Double positive disease.
34 yr old male
Medical history: Atopic dermatitis. Urticaria 3 yrs ago. ADD
Hospitalized 060922 with increasing leg edema
Lab:
Creatinin 64, eGFR>90 ml/min, CRP < 5, albumin 25, cholestrol 10.3 urin stix A 4+, B 5+, ACR 1353.2, u albumin 23,7 g/l
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Hvilke andre teknikker kan brukes?
Case 2
Kidney biopsy shows ten glomeruli without changes.
Tubules, interstitium and arterioles have no significant changes
No immune complex deposition (negative IF-biopsy)
Electron microscopic examination was preformed
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Case 2
Open capillary loops. Normal basement membranes. No immune complex deposition. Footprocesses are effaced/flattened and fused.
The clinical picture and the finding of effaced footprocesses by EM is consistent with minimal change nephropathy.
Damage of foot processes will give proteinuria
Hvordan behandler man “Minimal change disease” hos voksne?
64 yr old female
Medical history: Hypertension , stroke 06, paroxcystic atrial fibrillation
Admitted department of Cardiology jan. 16 with dyspnoea, weight gain 15 kg
Creatinine 65, eGFR> 90 ml/min, ACR 957 mg/mmol, urine albumine 4260 g/l, Dip stick 4+A ,5+B, s albumine 17, cholesterol 12.3, LDL 9.1
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Case 3
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Case 3
Nine glomeruli, two are completely sclerosed.
Glomeruli have several obliterated capillaries, but most are open with slightly thickend walls
Tubuli are normal, there is some interstitial fibrosis.
Immunofluorescense shows membranous granular deposition of IgG, C3, some IgM and light chains kappa and lambda
Immunohistochemical examination shows granular positivity for PLA2R along the basement membrane
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Subepithelial electron dense deposits (blue arrows), consistant with immune complex deposition.
Podocytes (epithelial cells) overlying the deposits are effaced and fused (orange arrows) and this causes the proteinuria.
Hva hadde pas. i case 3?
49 yr old male. Healthy
2 weeks with abdominal pain October -18.
BP 170/110, periorbital edema, dark urine, creatinin 125 eGFR 59 ml/min,
u-stix A3+, B4+, ACR 260 mg/mmol ,
u albumin 397 mg/l
Nephrittic syndrome with hematuria, proteinuria, hypertension
Creatinin 125, granulated casts in urine
No signs of ANCA associated vasculitis, kidneystone or infection.
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Case 4
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Case 4
14 glomeruli
5 glomeruli are almost or completely sclerotic.
9 glomeruli show slight increase in mesangial cellularity and matrix
1 glomerulus has cellular crescent
Tubular atrophy and interstitial fibrosis
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Case 4
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Immunfluorescens-biopsy showes mesangial deposits of IgA and C3
Hvilken diagnose hadde pas. i case 3?
Hva er behandlingen?
18 yr old female
Admitted 090919. Last 6 months fatigue, nausea. Last 2 weeks periorbital edema. At GP Hb 7.8. Microscopic hematuria and slight proteinuria.
At admission: BP 145/99. Creatinine 1690, urea 43,9, K 5,3, bicarbonat 14, phosfate 2,60, calsium 1,85. MPO ANCA >8,0.Normal urin output
Ultrasound kidneys: normal size
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Case 5
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Case 5
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Case 5
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Case 5
Hva kan man trekke ut av biopsien tatt av pas.kasus 5?
Hva er diagnosen ved pas.kasus 5?
Hvilke to terapiformer kan brukes ved ANCA vaskulitt?
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