Renal ultrastructural pathology lecture 2 me mi
Download
1 / 39

Renal Ultrastructural Pathology Lecture 2 Me - Mi - PowerPoint PPT Presentation


  • 131 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Renal Ultrastructural Pathology Lecture 2 Me - Mi' - nay


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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
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

bart.wagner@sth.nhs.uk

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

Mesangial interposition in response to subendothelial deposits

Mesangial deposits

Deposits are ‘moth eaten’




Renal ultrastructural pathology lecture 2 me mi

Monocyte interacting with endothelium deposits

Mesangial interposition


Renal ultrastructural pathology lecture 2 me mi

Mesangial matrix expansion – numerous deposits deposits

Mesangial interposition


Mcgn mpgn type 2 or linear dense deposit disease or dense deposit disease
MCGN / MPGN type 2 depositsorLinear dense deposit diseaseorDense deposit disease



Renal ultrastructural pathology lecture 2 me mi

Mesangial deposits deposits

Interrupted linear dense deposits


Renal ultrastructural pathology lecture 2 me mi

LDDD or MCGN type II deposits

Linear dense deposit

Mesangial interposition (between deposit and endothelial cell)


Renal ultrastructural pathology lecture 2 me mi

Dense deposit around tubular basement membrane deposits

Interstitial foam cell




Membranous glomerulonephritis1
Membranous Glomerulonephritis deposits

  • 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 deposits

  • Can find different stages on different loops

  • Therefore stage is usually bracketed


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous deposits

Appears similar to minimal change at low magnification


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous deposits

Tiny subepithelial deposits


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous deposits

Moderate numbers of small subepithelial deposits (IgG C3)


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous deposits

Occasional small epithelial deposits


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous deposits

Mesangial cell lysosomes


Renal ultrastructural pathology lecture 2 me mi

Stage 1 membranous deposits

Unstained section

Intralysosomal aurosomes / colloidal gold



Renal ultrastructural pathology lecture 2 me mi

Stage 2 membranous deposits

Numerous medium sized subepithelial deposits


Renal ultrastructural pathology lecture 2 me mi

Aggregates of filamentous actin in podocyte deposits

Stage 2 membranous

New basement membrane between subepithelial deposits – forming spikes


Renal ultrastructural pathology lecture 2 me mi

Stage 3 membranous deposits

Deposit lysis



Renal ultrastructural pathology lecture 2 me mi

Stage 4 membranous deposits

Deposits undergoing incorporation

Lysis of deposits

Fresh deposit



Minimal change nephropathy1
Minimal Change Nephropathy deposits

  • 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

Foot processes effaced deposits

Normal foot processes occasionally