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Discussion Case 17

Question #1and 2: The first photomicrograph highlights the presence of extracapillary proliferation and in the center of the glomerulus, the compressed tuft is seen. By definition, the presence of this proliferation in more than 50% of the glomeruli qualify for a diagnosis of crescentic glomerulonephritis.  Crescentic glomerulonephritis secondary to post-infectious glomerulonephritis is well documented and the presence in the second photomicrograph of a  subepithelial hump support the diagnosis.

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Discussion Case 16

 Question #1: The photomicrograph highlights the mesangial proliferation noted in the glomerulus. Different pattern of injury have been described in patients with C3 glomerulonephritis including mesangial proliferation. 

Question #2: The diagnosis of C3 glomerulopathy is supported by the presence of strong mesangial and to a lesser degree capillary staining for C3 on the immunofluorescence studies with negative immunoglobulins. The electron microscopy study shows mainly subendothelial non-organized dense deposits. Studies regarding C3 glomerulonephritis showed a EG CD46 mutation.

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Discussion Case 15

Question#1 and 2: Patients with Sjogren syndrome may show renal manifestations depending on the renal component affected : glomerular, tubulo-interstitial or vascular. In this patient, the interstitium shows infiltration by lymphocytes and plasma as has been described typically in patients with Sjogren syndrome. The lymphocytes and plasma cells are also noted in the minor salivary glands among other sites , and the biopsy of the oral mucosa is a major diagnostic procedure to support the diagnosis of Sjogren syndrome.

Question #2: The GMS stain is known as one of the two stains of choice for fungal organisms, the other is the PASD stain. The septae of the hyphae react with the silver component of the GMS stain to give the characteristic black color noted in the photomicrograph.

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Discussion Case 14

Questions #1 and 2: The photomicrograph showed the features consistent with renal dysplasia with dilated calyx, primitive ducts surrounded by smooth muscle fibers.  Glomeruli were difficult to identify. Renal dysplasia may be segmental or may involve one or both kidneys.  Renal dysplasia is considered as a developmental defect rather than a variant of a cystic kidney disease or an infectious process or a neoplasm. A loss of local gene transcription has been considered.

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Discussion Case 13

Question #1: The photomicrograph shows in the background, necrosis of the different elements present of the renal tissue ( glomeruli, tubules and interstitium), with extensive infiltration by polymorphonuclear cells. Also noted is a number of branching non-septated fungal hyphae. Patients with kidney transplantation are immunocompromised and the poor irrigation of the allograft as in this case leads to an opportunistic infection represented by the fungal organisms noted in the photomicrograph.

Question #2: The GMS stain is known as one of the two stains of choice for fungal organisms, the other is the PASD stain. The septae of the hyphae react with the silver component of the GMS stain to give the characteristic black color noted in the photomicrograph.