Slide Seminar 2 - May 2011

M S Ramaiah Medical College

KCIAPM SLIDE SEMINAR –NEPHROPATHOLOGY – 18th JUNE 2011

VENUE: M.S. RAMAIAH MEDICAL COLLEGE, BANGALORE

Moderator: Dr. Vijaya Mysorekar.

 

Case histories

CASE 1

A 28 year old male presented with the history of oliguria and bilateral swelling of limbs since 15 days.  BP

200/130 mmHg. Investigations: Serum creatinine 7.9 mg/dL, serum albumin 1.7 gm/dL. Renal biopsy was done.

1a
1b
1c
1d
1e 1f
1g 1h
1i 1j
1j 1l

CASE 2

A 70 year old male presented with the history of anorexia and vomiting since one week. He was treated for

pneumonia 15 days prior to this presentation.

BP 110/80 mmHg. Investigations: Urine volume 1900 ml; urine protein 4071 mg/24 hrs; urine microscopy – WBCs

8-10/HPF, RBCs 40-50/HPF; serum    creatinine 9 mg/dL. Renal biopsy was done.

2a
 

2b
2c

 

2d
2e 2f
2g 2h
2i 2j
2k 2l

CASE 3

A 31 year old male was diagnosed to have chronic myeloid leukemia. He was started on medication but discontinued it after 6

months and did not come for follow-up. Six months later, he developed anasarca, severe ascites and bilateral pleural effusion. BP

120/80 mmHg. Renal biopsy was done.

 

3a
 

3b
3c
 

3d
3e

 

3f
3g

CASE 4

A 26 year old male who was a known hypertensive on irregular treatment, was admitted with the complaints of

blurring of vision and headache since one month. BP 240/140 mm Hg, there was no oedema; peripheral pulses

were felt. Investigations: Urine protein 3300 mg/24 hrs; serum creatinine 6.1 mg/dL. Renal biopsy was done.

4a
 

4b
 

4c
4d
4e 4f
4g 4h
4i 4j
4k 4l
4m 4n

CASE 5

A 25 year old female presented with the history of episodes of fever since the last 2 months. She also had

bilateral pedal oedema. Investigations: Serum creatinine 1.4 mg/dL, urine protein 6800 mg/24 hrs. Renal biopsy

was done.

5a
 

5b
 

5c
5d
5e 5f
5g 5h
5ij 5j
5k 5l
5m 5n

CASE 6

A 48 year old male complained of pedal oedema and oliguria since 15 days. BP 140/90 mm Hg. Investigations:

Serum creatinine 2.6 mg/dL, urine      protein 3240mg/24 hrs. Renal biopsy was done.

6a
 

6b
6c 6d
6e
 

6f

CASE 7

A 14 year old male presented with pedal oedema and oliguria since one month. He had abdominal pain on and

off. Investigations: Serum creatinine 0.6 mg/dL. Urine microscopy showed numerous RBCs. Urine protein 3900

mg/24 hrs. Renal biopsy was done.

7a
 

7b
7c 7d
7e 7f
7g 7h
7i 7j
7k 7l

CASE 8

Biopsy from a transplanted kidney in a 29 year old male.

8a
 

8b
8c 8d
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CASE 9

A 28 year old male who had received a renal transplant one year back, had rising   serum creatinine levels. There

was history of drug defaulting. Transplant biopsy was done.

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9b
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9d
9e 9f
9f

CASE 10

A 52 year old female underwent renal transplantation for end stage kidney disease. The donor was her husband.

She received tacrolimus, mycophenolate mofetil and steroids prior to transplantation. Following the transplant, the urine output was

good for 12 hours, after which she became oliguric (urine output 5–10 ml/hr) with rising creatinine. Her prothrombin time   was

prolonged. She underwent dialysis and renal biopsy.

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10b
 

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10e 10f
10g 10h

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FINAL DIAGNOSIS

CASE SEREIS NO 2

Case 01Focal and segmental glomerulosclerosis (NOS) with moderate tubular atrophy and moderate interstitial fibrosis
Case 02Acute diffuse proliferative glomerulonephritis with crescent formation (post-infectious), with diabetes- induced changes and acute tubulointerstitial nephritis (severe degree)
Case 03Membranoproliferative glomerulonephritis (MPGN) secondary to chronic myeloid leukemia, with chronic tubulointerstitial nephritis (mild degree)
Case 04Crescentic and necrotising glomerulonephritis, pauci-immune, ANCA-associated, with acute tubulointerstitial nephritis (severe degree) and changes induced by malignant hypertension
Case 05Diffuse proliferative and sclerosing lupus nephritis with membranous lupus nephritis - Class IV-G (A/C) + V. Activity index: 10/24, Chronicity index: 4/12
Case 06Renal amyloidosis with chronic tubulointerstitial nephritis (mild degree)
Case 07Mesangioproliferative glomerulonephritis - Henoch Schönlein purpura
Case 08Chronic active antibody-mediated rejection (transplant glomerulopathy-severe, interstitial fibrosis and tubular atrophy-moderate) Banff scoring for chronic changes – ci1, ct2, cg3, mm2, ti1, cv0, ah3
Case 09Acute cellular rejection Banff Type IA and IIB (g1, i2, t2, v2, ah0, cg0, ci0, ct 0, cv0)
Case 10Calcineurin Inhibitor (tacrolimus)-induced thrombotic microangiopathy with early acute tubular injury

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