Renal module

Week One:
Primary Glomerulonephritis.

Normando C. Gonzaga, M.D., F.P.S.P

Review of Histology
Below is the PAS stain of a normal glomerulus. Study
the morphology and compare this with the subsequent
cases. Describe the cellularity. How many cells should
be present in the mesangial matrix?
Slide A. In slide A Locate the capillaries, mesangial
stalk, and mesangial cells.
2 What are the functions of the mesangial cells?
Slide B.Identify the mesangial cells, endothelial cells,
and the foot processes.
Slide C. Identify the foot processes,
basement membrane, and visceral
epithelial cell.
Slide D.
1. Identify the lamina densa, lamina rara externa, and lamina rara
interna
2. What will be the terms used for dense deposits in the a. lamina
densa. c. lamina rara externa, c. lamina rara interna
 Case 1.

A 10-year old boy consulted a physician because of

tea colored urine and puffiness of the eyelids noted
especially in the morning. This symptoms were
noticed 3 weeks after he had fever and sore throat.
Slide 1-a:Below is the H& E section of the renal
biopsy. Describe the glomerulus. particularly the
cellularity and the leucocytic infiltrates
Slide 1-b: IF of the case. What major antibodies
would be positive?
Describe the classical appearance of IgG and C3.
Slide 1-c. Locate and describe the dense deposits.
What makes this lesion acute and exudative based on
this micrograph?
 Case 2
A 16-year old female was discovered to have
microscopic hematuria on routine urinalysis during the
entrance physical examination. Immunofluorescent
microscopy shows deposits of IgA in the mesangium
and few deposits in the basement membrane.
 Case 2.. Slide 2.a. Below is the appearance of
immunofluorescence to IgA antibody. IgG and IgM are
negative.
Slide 2.b. Describe this PAS-stained glomerulus of
this case.
Slide 2.c.Below is another light microscopic pattern
of this case. Describe the glomerulus.
Slide 2.d.Localize the dense deposits(D) of this case
as shown in this micrograph.
Case 2 Summary

 What is your final diagnosis of this case?

 What is the most important diagnostic tool
in the diagnosis of this case?
 Case 3.

A 5-year old boy was noticed to have periorbital and pedal

edema for the last 2 months. Urinalysis shows 3+ protein.
Blood exam shows 40 g/L protein and 1.80 mmol/l
cholesterol. Renal biopsy discloses normocellular glomeruli.
Immunofluorescence is negative to all antibodies.
Below are the transmission electron microscope
(left) and scannic electron microscope (right)
findings.
Case 3. SummaryQuestions

 What is your diagnosis?

 What is the most important diagnostic tool
in the diagnosis of this lesion?
 What is the prognosis?
 Case 4.

A 30 year-old male was diagnosed to have schistosomiasis a

year ago. Two months prior to consultation, patient
complained of generalized edema. Urinalysis shows 4+
protein. Blood exam: protein – 2.5 /L, cholesterol – 2.00
mmo/l
Below are the light microscopic findings: H& E (left),
Silver impregnation(right)
The picture on the left shows the IF findings with IgG;
on the right, the EM findings.
 Case 4: Questions

 What is your diagnosis?

 Describe the light microscopic findings as shown in the
micrographs.
 Describe the IF and EM findings as shown in the
micrographs.
 What is the relationship of Schistosomiasis with the
renal lesion?
 Case 5
A 25-year old female consulted a nephrologist
because of blood in the urine. The physician after
her physicaql examination find out that she has
also generalized edema. Urinalysis showed 3+
protein. Blood chemistry revealed low protein
and high triglycerides and cholesterol. On top of
that her BP is 160/100.
Below are the PAS stain(left) and silver stain(right) of
the renal biopsy.
Below are the EM findings.
 Case 5: Questions

 What are the important light microscopic findings?

 What is the most important immunofluorescence
finding?
 Describe the ultrastructural features which correspond to
the light microscopic findings.
 Differentiate the 3 types of this Glomerulonephritis.