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RENAL BIOPSY
INTERPRETATION
Dr Bruce LyonsConsultant Histopathologist
Derriford Hospital
(for the MRCPath Exam.)
Cutting & Staining
• Paraffin Serials
• H&E: S1 S10 S20
• Sliver (Gomori)
• PAS
• MSB (fibrin)
• EVG
• Congo Red
Cases for final MRCPath exam.
• IgA nephropathy / Henoch-
Schonlein Purpura
• Pauci-immune crescentic GN
(Wegener’s, Microscopic PAN)
• Anti-GBM GN (“Goodpasture’s”)
• Lupus (WHO III, IV, V esp)
• Diffuse Membranous GN
• Diffuse Mesangio-capillary GN
• Diffuse Endocapillary prolif. GN
• Minimal Change
• Alport’s
• Thin membrane nephropathy
• [Amyloid/Light chain nephropathy]
• FSGS
• Myeloma cast nephropathy
• TIN vs. Ascending infection
• ATN
• Essential hypertension
• Diabetes mellitus
• Malignant hypertension
• HUS
• TTP
• Scleroderma
• Vasculitis
• Renovascular disease/Embolus
Writing a report
• Introduction
• Glomeruli
• Tubules & Interstitium
• Vessels
• Immunohistochemistry
• Electron Microscopy
• Conclusion/Comments:
Renal cases for MRCPath.(the beauty of the Exam. Case)
• ‘Barn-door’ examples
(morphology)
• +/- Common 2° conditions
(esp. vascular)
• ‘Normal’ (looking)
Gathering the information
• ‘Barn-door’ examples
(morphology)
• +/- Common 2° conditions
(esp. vascular)
• ‘Normal’ (looking)
Cases for final MRCPath exam.
• IgA nephropathy / Henoch-
Schonlein Purpura
• Pauci-immune crescentic GN
(Wegener’s, Microscopic PAN)
• Anti-GBM GN (“Goodpasture’s”)
• Lupus (WHO III, IV, V esp)
• Diffuse Membranous GN
• Diffuse Mesangio-capillary GN
• Diffuse Endocapillary prolif. GN
• Minimal Change
• Alport’s
• Thin membrane nephropathy
• [Amyloid/Light chain nephropathy]
• FSGS
• Myeloma cast nephropathy
• TIN vs. Ascending infection
• ATN
• Essential hypertension
• Diabetes mellitus
• Malignant hypertension
• HUS
• TTP
• Scleroderma
• Vasculitis
• Renovascular disease/Embolus
Cases for final MRCPath exam.
• IgA nephropathy/ Henoch-
Schonlein Purpura
• Pauci-immune crescentic GN
(Wegener’s, Microscopic PAN)
• Anti-GBM GN (“Goodpasture’s”)
• Lupus (WHO III, IV, V esp)
• Diffuse Membranous GN
• Diffuse mesangio-capillary GN
• Diffuse endocapillary prolif. GN
• Minimal Change
• Alport’s
• Thin membrane nephropathy
• [Amyloid/Light chain nephropathy]
• FSGS
• Myeloma cast nephropathy
• TIN vs. Ascending infection
• ATN
• Essential hypertension
• Diabetes mellitus
• Malignant hypertension
• HUS
• TTP
• Scleroderma
• Vasculitis
• Renovascular disease/Embolus
Cases for final MRCPath exam.
• IgA nephropathy/ Henoch-
Schonlein Purpura
• Pauci-immune crescentic GN
(Wegener’s, Microscopic PAN)
• Anti-GBM GN (“Goodpasture’s”)
• Lupus (WHO III, IV, V esp)
• Diffuse Membranous GN
• Diffuse mesangio-capillary GN
• Diffuse endocapillary prolif. GN
• Minimal Change
• Alport’s
• Thin membrane nephropathy
• [Amyloid/Light chain nephropathy]
• FSGS
• Myeloma cast nephropathy
• TIN vs. Ascending infection
• ATN
• Essential hypertension
• Diabetes mellitus
• Malignant hypertension
• HUS
• TTP
• Scleroderma
• Vasculitis
• Renovascular disease/Embolus
Cases for final MRCPath exam.
• IgA nephropathy/ Henoch-
Schonlein Purpura
• Pauci-immune crescentic GN
(Wegener’s, Microscopic PAN)
• Anti-GBM GN (“Goodpasture’s”)
• Lupus (WHO III, IV, V esp)
• Membranous GN
• Mesangio-capillary GN
• Endocapillary proliferative GN
• Minimal Change
• Alport’s
• Thin membrane nephropathy
• [Amyloid/Light chain nephropathy]
• FSGS
• Myeloma cast nephropathy
• TIN vs. Ascending infection
• ATN
• Essential hypertension
• Diabetes mellitus
• Malignant hypertension
• HUS
• TTP
• Scleroderma
• Vasculitis
• Renovascular disease/Embolus
Myeloma Cast Nephropathy
• MYELOMA• ‘Hard’, cracked casts
• Giant-cell reaction
• “Thyroidisation”(chronicity)
Cases for final MRCPath exam.
• IgA nephropathy/ Henoch-
Schonlein Purpura
• Pauci-immune crescentic GN
(Wegener’s, Microscopic PAN)
• Anti-GBM GN (“Goodpasture’s”)
• Lupus (WHO III, IV, V esp)
• Membranous GN
• Mesangio-capillary GN
• Endocapillary proliferative GN
• Minimal Change
• Alport’s
• Thin membrane nephropathy
• [Amyloid/Light chain nephropathy]
• FSGS
• Myeloma cast nephropathy
• TIN vs. Ascending infection
• ATN
• Essential hypertension
• Diabetes mellitus
• Malignant hypertension
• HUS
• TTP
• Scleroderma
• Vasculitis
• Renovascular disease/Embolus
Diabetes Mellitus
• Nodular sclerotic lesion:
Kimmelstiel-Wilson (KW)
nodule
• Global (“diffuse”)
sclerotic lesion:
Cases for final MRCPath exam.
• IgA nephropathy/ Henoch-
Schonlein Purpura
• Pauci-immune crescentic GN
(Wegener’s, Microscopic PAN)
• Anti-GBM GN (“Goodpasture’s”)
• Lupus (WHO III, IV, V esp)
• Membranous GN
• Mesangio-capillary GN
• Endocapillary proliferative GN
• Minimal Change
• Alport’s
• Thin membrane nephropathy
• [Amyloid/Light chain nephropathy]
• FSGS
• Myeloma cast nephropathy
• TIN
• ATN vs. Ascending infection
• Essential hypertension
• Diabetes mellitus
• Malignant hypertension
• HUS
• TTP
• Scleroderma
• Vasculitis
• Renovascular disease/Embolus
Cases for final MRCPath exam.
• IgA nephropathy/ Henoch-
Schonlein Purpura
• Pauci-immune crescentic GN
(Wegener’s, Microscopic PAN)
• Anti-GBM GN (“Goodpasture’s”)
• Lupus (WHO III, IV, V esp)
• Membranous GN
• Mesangio-capillary GN
• Endocapillary proliferative GN
• Minimal Change
• Alport’s
• Thin membrane nephropathy
• [Amyloid/Light chain nephropathy]
• FSGS
• Myeloma cast nephropathy
• TIN
• ATN vs. Ascending infection
• Essential hypertension
• Diabetes mellitus
• Malignant hypertension
• HUS
• TTP
• Scleroderma
• Vasculitis
• Renovascular disease/Embolus
Thrombotic Microangiopathy (TMA)
• 4 causes (for the exam!)
• Malignant HTN
• HUS
• TTP
• Screroderma ‘crisis’
Thrombotic Microangiopathy (TMA)
• “Acute” TMA
• TMA heals with “onion-
skinning” (myxoid
fibroblastic thickening)
Cases for final MRCPath exam.
• IgA nephropathy/ Henoch-
Schonlein Purpura
• Pauci-immune crescentic GN
(Wegener’s, Microscopic PAN)
• Anti-GBM GN (“Goodpasture’s”)
• Lupus (WHO III, IV, V esp)
• Membranous GN
• Mesangio-capillary GN
• Endocapillary proliferative GN
• Minimal Change
• Alport’s
• Thin membrane nephropathy
• [Amyloid/Light chain nephropathy]
• FSGS
• Myeloma cast nephropathy
• TIN vs. Ascending infection
• ATN
• Essential hypertension
• Diabetes mellitus
• Malignant hypertension
• HUS
• TTP
• Scleroderma
• Vasculitis
• Renovascular disease/Embolus