Renal Pathology Lab November 4, 2013. Renal Pathology Lab Case 1.
Renal Ultrastructural Pathology Lecture 2 Me - Mi
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Transcript of Renal Ultrastructural Pathology Lecture 2 Me - Mi
Renal Ultrastructural PathologyRenal Ultrastructural PathologyLecture 2 Me - MiLecture 2 Me - Mi
Bart E Wagner Bart E Wagner BSc CSc FIBMS Dip Ult PathBSc CSc FIBMS Dip Ult Path
Chief Biomedical ScientistChief Biomedical ScientistElectron Microscopy SectionElectron Microscopy SectionHistopathology DepartmentHistopathology DepartmentNorthern General HospitalNorthern General Hospital
SheffieldSheffieldSouth YorkshireSouth Yorkshire
UKUKS5 7AUS5 7AU
[email protected]+44(0)114-27 14154Tel+44(0)114-27 14154
Basic Renal EM workshop
Southampton
September 30th 2011
Histopathology DepartmentNorthern General Hospital
Renal ultrastructural pathologyRenal ultrastructural pathologyLecture 2 - TopicsLecture 2 - Topics
1.1. Mesangio Capillary Glomerulo Nephritis MCGN type IMesangio Capillary Glomerulo Nephritis MCGN type I
2.2. Mesangio Capillary Glomerulo Nephritis MCGN type II Mesangio Capillary Glomerulo Nephritis MCGN type II (linear dense deposit disease)(linear dense deposit disease)
3.3. Membranous Glomerulo NephritisMembranous Glomerulo Nephritis
4.4. Minimal Change nephropathyMinimal Change nephropathy
Mesangiocapillaryglomerulonephritis Mesangiocapillaryglomerulonephritis MCGN type 1MCGN type 1
or or Membranoproliferativeglomerulonephritis Membranoproliferativeglomerulonephritis
MPGN type 1MPGN type 1
Mesangiocapillaryglomerulonephritis MCGN Mesangiocapillaryglomerulonephritis MCGN type 1type 1
Membranoproliferativeglomerulonephritis Membranoproliferativeglomerulonephritis MPGN type 1 & 2MPGN type 1 & 2
Immunofluorescence: C3 mainlyImmunofluorescence: C3 mainly
Can be occasionally confused with subacute postinfectious GNCan be occasionally confused with subacute postinfectious GN
Accentuation of lobular architecture
Accentuation of lobular architecture
Mesangial interposition
Mesangial deposits Deposits are ‘moth eaten’
Mesangial interposition in response to subendothelial deposits
Hypercellular nodular glomerular sclerosis
Hypercellular glomerulus
Mesangial interpositionMonocyte interacting with endothelium
Mesangial matrix expansion – numerous depositsMesangial interposition
MCGN / MPGN type 2MCGN / MPGN type 2oror
Linear dense deposit diseaseLinear dense deposit diseaseoror
Dense deposit diseaseDense deposit disease
Nodular glomerular sclerosis
Interrupted linear dense deposits
Mesangial deposits
Linear dense depositMesangial interposition (between deposit and endothelial cell)
LDDD or MCGN type II
Dense deposit around tubular basement membrane Interstitial foam cell
Subendothelial expansion but no deposit or interposition
Membranous Membranous GlomerulonephritisGlomerulonephritis
Membranous Membranous GlomerulonephritisGlomerulonephritis
Stage 1: Small subepithelial deposits – no spikes on silver stainStage 1: Small subepithelial deposits – no spikes on silver stain
Stage 2: New basement membrane around lateral border of Stage 2: New basement membrane around lateral border of deposits – spikes present on silver staindeposits – spikes present on silver stain
Stage 3: Occasional lysed deposit, occasional new basement Stage 3: Occasional lysed deposit, occasional new basement membrane between deposit and podocytemembrane between deposit and podocyte
Stage 4: Occasionally find mesangial cell undergoing interposition, Stage 4: Occasionally find mesangial cell undergoing interposition, glomerulosclerosis – silver stain chain ropeglomerulosclerosis – silver stain chain rope
Membranous GNMembranous GN
Can find different stages on different loopsCan find different stages on different loops
Therefore stage is usually bracketedTherefore stage is usually bracketed
Stage 1 membranous
Appears similar to minimal change at low magnification
Tiny subepithelial deposits
Stage 1 membranous
Moderate numbers of small subepithelial deposits (IgG C3)
Stage 1 membranous
Occasional small epithelial deposits
Stage 1 membranous
Stage 1 membranous
Mesangial cell lysosomes
Unstained section Intralysosomal aurosomes / colloidal gold
Stage 1 membranous
Stage 2 membranous
Stage 2 membranous
Numerous medium sized subepithelial deposits
Stage 2 membranous
New basement membrane between subepithelial deposits – forming spikes
Aggregates of filamentous actin in podocyte
Deposit lysis
Stage 3 membranous
Stage 4/chronic membranous
Stage 4 membranous
Lysis of depositsDeposits undergoing incorporation Fresh deposit
Minimal Change NephropathyMinimal Change Nephropathy
Minimal Change NephropathyMinimal Change Nephropathy
Histologically normal glomeruli in context of nephrotic syndromeHistologically normal glomeruli in context of nephrotic syndrome
Trace IgM on IFTrace IgM on IF
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CaveatCaveat
Not a good correlation between level of proteinuria and extent of foot Not a good correlation between level of proteinuria and extent of foot process effacement within a single glomerulus due to variability of process effacement within a single glomerulus due to variability of degree of pathology between glomeruli.degree of pathology between glomeruli.
Proteinuria reflects mean of foot process effacement.Proteinuria reflects mean of foot process effacement.
Normal-looking glomerulus
Normal foot processes occasionally
Foot processes effaced
Foot process effacement
Tiny mesangial deposits (IgM)