Renal ultrastructural pathology lecture 2 me mi
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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

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Renal ultrastructural pathology lecture 2 me mi

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

[email protected]

Tel+44(0)114-27 14154

Histopathology Department

Northern General Hospital


Renal ultrastructural pathology lecture 2 topics

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


Renal ultrastructural pathology lecture 2 me mi

Mesangiocapillaryglomerulonephritis MCGN type 1or Membranoproliferativeglomerulonephritis MPGN type 1


Renal ultrastructural pathology lecture 2 me mi

Mesangiocapillaryglomerulonephritis MCGN type 1Membranoproliferativeglomerulonephritis MPGN type 1 & 2

  • Immunofluorescence: C3 mainly

  • Can be occasionally confused with subacutepostinfectious GN


Renal ultrastructural pathology lecture 2 me mi

Accentuation of lobular architecture


Renal ultrastructural pathology lecture 2 me mi

Accentuation of lobular architecture


Renal ultrastructural pathology lecture 2 me mi

Mesangial interposition


Renal ultrastructural pathology lecture 2 me mi

Mesangial interposition in response to subendothelial deposits

Mesangial deposits

Deposits are ‘moth eaten’


Renal ultrastructural pathology lecture 2 me mi

Hypercellular nodular glomerular sclerosis


Renal ultrastructural pathology lecture 2 me mi

Hypercellular glomerulus


Renal ultrastructural pathology lecture 2 me mi

Monocyte interacting with endothelium

Mesangial interposition


Renal ultrastructural pathology lecture 2 me mi

Mesangial matrix expansion – numerous deposits

Mesangial interposition


Mcgn mpgn type 2 or linear dense deposit disease or dense deposit disease

MCGN / MPGN type 2orLinear dense deposit diseaseorDense deposit disease


Renal ultrastructural pathology lecture 2 me mi

Nodular glomerular sclerosis


Renal ultrastructural pathology lecture 2 me mi

Mesangial deposits

Interrupted linear dense deposits


Renal ultrastructural pathology lecture 2 me mi

LDDD or MCGN type II

Linear dense deposit

Mesangial interposition (between deposit and endothelial cell)


Renal ultrastructural pathology lecture 2 me mi

Dense deposit around tubular basement membrane

Interstitial foam cell


Renal ultrastructural pathology lecture 2 me mi

Subendothelial expansion but no deposit or interposition


Membranous glomerulonephritis

Membranous Glomerulonephritis


Membranous glomerulonephritis1

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


Membranous gn

Membranous GN

  • Can find different stages on different loops

  • Therefore stage is usually bracketed


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous

Appears similar to minimal change at low magnification


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous

Tiny subepithelial deposits


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous

Moderate numbers of small subepithelial deposits (IgG C3)


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous

Occasional small epithelial deposits


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous

Mesangial cell lysosomes


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous

Unstained section

Intralysosomal aurosomes / colloidal gold


Renal ultrastructural pathology lecture 2 me mi

Stage 2 membranous


Renal ultrastructural pathology lecture 2 me mi

Stage 2 membranous

Numerous medium sized subepithelial deposits


Renal ultrastructural pathology lecture 2 me mi

Aggregates of filamentous actin in podocyte

Stage 2 membranous

New basement membrane between subepithelial deposits – forming spikes


Renal ultrastructural pathology lecture 2 me mi

Stage 3 membranous

Deposit lysis


Renal ultrastructural pathology lecture 2 me mi

Stage 4/chronic membranous


Renal ultrastructural pathology lecture 2 me mi

Stage 4 membranous

Deposits undergoing incorporation

Lysis of deposits

Fresh deposit


Minimal change nephropathy

Minimal Change Nephropathy


Minimal change nephropathy1

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.


Renal ultrastructural pathology lecture 2 me mi

Normal-looking glomerulus


Renal ultrastructural pathology lecture 2 me mi

Foot processes effaced

Normal foot processes occasionally


Renal ultrastructural pathology lecture 2 me mi

Foot process effacement


Renal ultrastructural pathology lecture 2 me mi

Tiny mesangial deposits (IgM)


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