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Renal, Male Reproductive Module. Normando C. Gonzaga, M.D, F.P.SP., I.F. CAP. Case 1.
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Renal, Male Reproductive Module Normando C. Gonzaga, M.D, F.P.SP., I.F. CAP
Case 1 A 10-year old boy consulted a physician because of tea colored urine and puffiness of the eyelids especially noted in the morning. Blood pressure of the patient is 140/90. These symptoms were noticed 3 weeks after he had fever and sore throat. Laboratory examinations disclose the following: urinalysis: protein-4+, sugar, - neg,leucocytes – 0-1/hpf, rbc- 10-20/hpf, red cell cast- 1-2/lpf, granular cast – 0-1/lpf, waxy cast- 0-1/lpf;.
seat work/ homework • What is your syndrome diagnosis, morphologic diagnosis? Give the bases for your diagnoses. • What is the most important laboratory finding which is highly suggestive of the clinico-morphologic diagnosis? • What other laboratory work-ups could could suggest that this is a post infectious lesion? • What immunofluorescence finding is expected. Describe the classical pattern. • What would be the prognosis in children? In adults?
Case 2 A 16-year old female was discovered to have microscopic hematuria on routine urinalysis during the entrance physical examination. Immunofluorescent microscopy shows the following: IgG – negative; IgM- 1+, basement membrane; IgA – 2+, mesangium; C3-1+, basement membrane and mesangium; C1q – negative; Fibrinogen – 2+ basement membrane and mesangium.
Case 2.. Slide 2.a. Below is the appearance of immunofluorescence to IgA antibody. IgG and IgM are negative. Describe the IF findings.
Seatwork/homework • What is your syndrome and clinico-morphologic diagnoses? • Describe the possible light microscopic patterns of this type of glomerulopathy based on WHO. • Describe the expected pattern of dense deposits in the electron microscope. • What would be the best diagnostic tool for this particular case? • If this patient manifests dermatologic and abdominal symtptoms aside from hematuria, what would be the most apropriate clinico-pathologic diagnosis?
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 1.5 mg/ dl protein and 250 mg/dl cholesterol. Renal biopsy discloses normocellular glomeruli. Immunofluorescence is negative to all antibodies.
Electron microscopy • Scanning electronmicrograph→ • ←Transmission electronmicrograph • Correlate the two micrographs and describe the common finding.
Seatwork/homework • What is your syndrome diagnosis and clinico-morphologic diagnoses? • What is the most specific diagnostic tool used in renal biopsy for the diagnosis of this case? • What is the prognosis of this case? • What pathologic variant would show light microscopic findings and possible immunofluorescent findings. In a table form, give the differences between this case and the other clinicopathologic variant.
Case 4 A 25-year old female consulted a nephrologist because of bubbly urine. The physician after working her up find out that she also has sign and symptoms of nephrotic syndrome. On top of that her BP is 160/100.Her urinalysis shows numerous sediments. The patient has been diagnosed with lupus erythematosus 5 years ago.
Seatwork/homework • Immunofluorescent findings show”full house” effect. Explain what full house effect means. Give the significance • Enumerate the WHO classification of lupus nephritis. Compare this classification with the ISN/RPS classification. • Which class is the most common and has the worst prognosis? • Explain the term ‘transformation’ in lupus nephritis. • What do you mean by activity index and chronicity index in lupus nephritis.?
Case 5 A 25-year old male was admitted in the emergency room because of high fever associated with flank pain. CBC shows WBC of 15, 000/cu. mm. Urinalysis shows: protein = 2 + RBC = 4/lpf WBC = too numerous to count
The patient died 3 days after admission because of septic shock. In autopsy, below are the findings in the kidney. Describe the histologic findings.
Summary Questions Give your diagnosis. What is the most common etiologic agent of this lesion? What are the routes of infection? What laboratory exam confirms the diagnosis? Why?
Case 6 A 40-year old male suddenly experienced severe headache. Upon consultation, his BP is noted to be 200/ 120. Past history shows normal BP on regular check-ups. Antihypertensives are immediately given. However, BP remains in the range of 200/120 – 180/ 100. Nicardipine drip is instituted. 2 days later, patient died because of intracerebral hemorrhage.
If autopsied, which of the two gross specimens of the kidney would be compatible with the patient’s condition? Describe each. A B
Which of the 2 microscopic findings of the arteriole of the kidney is compatible with this case? Describe each . A B
Case 7 A 45 year old female consulted a physician because of blood clot in the urine. Six months prior to consultation, she has been experiencing on and off flank pain. On physical, examination, the physician appreciated an abdominal mass.
Summary Questions Give your diagnosis. What are the factors in the prognosis of this case? If the tumor of this patient originated in the pelvis of the kidney, what would be the histologic type?
Case 8A 65-year old male consulted a physician because of difficulty of urination for the past 6 months. He has also observed his urine to be tea colored. On rectal examination, a firm enlarged mass is palpated anteriorly. Ultrasound shows calcification in the enlarged prostate. Six months ago, his PSA level showed 6 ng/ml. Repeat PSA on admission shows 15 ng/ml.
Which of the two histologic sections is compatible with the patient’s condition? Describe each. A B
1. What is the significance of the PSA determination in the diagnosis of prostatic diseases? 2. Differentiate free PSA from predicted PSA level. 3. Why should PSA determination be repeated within 3 to 6 months after the first determination?
