1 / 39

Renal Ultrastructural Pathology Lecture 2 Me - Mi

Basic Renal EM workshop Southampton September 30 th 2011. Renal Ultrastructural Pathology Lecture 2 Me - Mi. Bart E Wagner BSc CSc FIBMS Dip Ult Path Chief Biomedical Scientist Electron Microscopy Section Histopathology Department Northern General Hospital Sheffield

nay
Download Presentation

Renal Ultrastructural Pathology Lecture 2 Me - Mi

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Basic Renal EM workshop Southampton September 30th 2011 Renal Ultrastructural PathologyLecture 2 Me - Mi Bart E Wagner BSc CSc FIBMS Dip Ult Path Chief Biomedical Scientist Electron Microscopy Section Histopathology Department Northern General Hospital Sheffield South Yorkshire UK S5 7AU bart.wagner@sth.nhs.uk Tel+44(0)114-27 14154 Histopathology Department Northern General Hospital

  2. Renal ultrastructural pathologyLecture 2 - Topics • Mesangio Capillary Glomerulo Nephritis MCGN type I • Mesangio Capillary Glomerulo Nephritis MCGN type II (linear dense deposit disease) • Membranous Glomerulo Nephritis • Minimal Change nephropathy

  3. Mesangiocapillaryglomerulonephritis MCGN type 1or Membranoproliferativeglomerulonephritis MPGN type 1

  4. Mesangiocapillaryglomerulonephritis MCGN type 1Membranoproliferativeglomerulonephritis MPGN type 1 & 2 • Immunofluorescence: C3 mainly • Can be occasionally confused with subacutepostinfectious GN

  5. Accentuation of lobular architecture

  6. Accentuation of lobular architecture

  7. Mesangial interposition

  8. Mesangial interposition in response to subendothelial deposits Mesangial deposits Deposits are ‘moth eaten’

  9. Hypercellular nodular glomerular sclerosis

  10. Hypercellular glomerulus

  11. Monocyte interacting with endothelium Mesangial interposition

  12. Mesangial matrix expansion – numerous deposits Mesangial interposition

  13. MCGN / MPGN type 2orLinear dense deposit diseaseorDense deposit disease

  14. Nodular glomerular sclerosis

  15. Mesangial deposits Interrupted linear dense deposits

  16. LDDD or MCGN type II Linear dense deposit Mesangial interposition (between deposit and endothelial cell)

  17. Dense deposit around tubular basement membrane Interstitial foam cell

  18. Subendothelial expansion but no deposit or interposition

  19. Membranous Glomerulonephritis

  20. Membranous Glomerulonephritis • Stage 1: Small subepithelial deposits – no spikes on silver stain • Stage 2: New basement membrane around lateral border of deposits – spikes present on silver stain • Stage 3: Occasional lysed deposit, occasional new basement membrane between deposit and podocyte • Stage 4: Occasionally find mesangial cell undergoing interposition, glomerulosclerosis – silver stain chain rope

  21. Membranous GN • Can find different stages on different loops • Therefore stage is usually bracketed

  22. Stage 1 membranous Appears similar to minimal change at low magnification

  23. Stage 1 membranous Tiny subepithelial deposits

  24. Stage 1 membranous Moderate numbers of small subepithelial deposits (IgG C3)

  25. Stage 1 membranous Occasional small epithelial deposits

  26. Stage 1 membranous Mesangial cell lysosomes

  27. Stage 1 membranous Unstained section Intralysosomal aurosomes / colloidal gold

  28. Stage 2 membranous

  29. Stage 2 membranous Numerous medium sized subepithelial deposits

  30. Aggregates of filamentous actin in podocyte Stage 2 membranous New basement membrane between subepithelial deposits – forming spikes

  31. Stage 3 membranous Deposit lysis

  32. Stage 4/chronic membranous

  33. Stage 4 membranous Deposits undergoing incorporation Lysis of deposits Fresh deposit

  34. Minimal Change Nephropathy

  35. Minimal Change Nephropathy • Histologically normal glomeruli in context of nephrotic syndrome • Trace IgM on IF ------------------------------------------------------------------ Caveat • Not a good correlation between level of proteinuria and extent of foot process effacement within a single glomerulus due to variability of degree of pathology between glomeruli. • Proteinuria reflects mean of foot process effacement.

  36. Normal-looking glomerulus

  37. Foot processes effaced Normal foot processes occasionally

  38. Foot process effacement

  39. Tiny mesangial deposits (IgM)

More Related