Renal Pathology In Patients Research Articles

Renal haemodynamic characteristics and their correlation with renal pathology in patients with systemic lupus erythematosus

SUMMARY:To clarify the characteristics of renal haemodynamics and their correlation with renal pathology in patients with systemic lupus erythematosus (SLE), renal function and renal biopsy findings from 101 SLE patients were analysed retrospectively. Glomerular filtration rate (GFR) and renal plasma flow (RPF) were examined simultaneously. Filtration fraction (FF) was calculated from the values obtained for GFR and RPF (GFR/RPF). The GFR was low in one‐third and within normal limits in two‐thirds of class IV patients with lupus nephritis (LN). In contrast, high RPF was observed in half of class IV patients. As a result, over 70% of class IV patients possessed a very low FF (less than 15%). The sensitivity of very low FF for class IV LN was significantly higher than that of low GFR. In conclusion, low FF was frequently recognized, especially in patients with diffuse proliferative LN. Decreased FF was a highly sensitive indicator of diffuse proliferative LN. Thus, determination of renal haemodynamics, including FF, may be a useful clinical parameter for evaluating renal involvement in patients with SLE.

Nonmalignant Renal Disease in Pediatric Patients With Beckwith-Wiedemann Syndrome

OBJECTTVE. The objective of this retrospective review was to determine the incidence and spectrum of nonmalignant renal disease in patients with Beckwith-Wiedemann syndrome. MATERIALS AND METHODS. Patient records were obtained from the Beckwith-Wiedemann Registry of the National Cancer Institute. Imaging findings and medical records of 152 neonates, infants, children, and adults with Beckwith-Wiedemann syndrome (age range, 1 day to 30 years old; median age, 1 year 3 months old) were retrospectively reviewed by three radiologists. Available pathologic material also was reviewed. RESULTS. Thirty-eight (25%) of 152 patients with Beckwith-Wiedemann syndrome had 45 nonmalignant renal abnormalities, including medullary renal cysts (n = 19, 13%), caliceal diverticula (n = 2, l%), hydronephrosis (n = 18, 12%), and nephrolithiasis tn = 6,4%). Thirty-three (8’7%) of the 38 patients with nonmalignant renal disease were asymptomatic. Clinical manifestations of the remaining five patients, included unnary tract infections (n = 4) and flank pain due to obstructive stone disease (n = 1). Nonmalignant renal disease was mistaken for Wilms’ tumor and nonmalignant renal disease. CONCLUSION. Nonmalignant renal abnormalities occur in approximately 25% of patients with Beckwith-Wiedemann syndrome but are generally asymptomatic. Nonmalignant renal abnormalities should be considered in the differential diagnosis of a mass revealed during screening sonography of a patient with Beckwith-Wiedemann syndrome to avoid unnecessary surgery. Editorial Comment: The authors reviewed the patient records of the Beckwith-Wiedemann registry at the National Cancer Institute. The records included 152 patients 1 to 30 years old (median age 1 year 3 months). Of these patients 38 (25%) actually had 45 nonmalignant renal processes, including medullary cysts (19), caliceal diverticula (2), hydronephrosis (18) and nephrolithiasis (6). Of these patients 33 (87%) were asymptomatic when the abnormality was discovered and the remainder had varying symptoms, including urinary tract infection in 4 and flank pain due to obstructive stone disease in 1. In 2 of these patients nepktomy was performed for suspected Wilms tumor when in fact the patients had nonmalignant renal disease. The most important message in this study is the recognition that not all renal pathology in patients with the Beckwith-Wiedemann syndrome is secondary to Wilms tumors, and that adequate evaluation clinically and radiographically is important before surgery is performed.

Renal pathology in patients with primary hyperaldosteronism secondary to an adrenal cortical adenoma

The cause of persistent hypertension following the removal of an aldosterone-producing adrenal adenoma is unknown. The purpose of this study was to determine whether this occurrence is due to existing renal histopathologic damage. Thirty-two patients with primary hyperaldosteronism due to an aldosterone-secreting adrenal cortical adenoma underwent open renal biopsy at the time of unilateral adrenalectomy. Biopsy results were correlated with the duration and severity of hypertension before and after surgery. Nineteen patients were cured of their hypertension postoperatively, whereas 13 patients had persistent diastolic hypertension. Statistical analysis of these two groups revealed no difference when renal histopathologic variables, preoperative severity of hypertension, or preoperative duration of hypertension were compared. Persistent hypertension in these patients does not appear to be due to renal histopathologic changes; coexisting essential hypertension is a more likely cause.

Renal pathology in patients with reflux nephropathy. The turning point in irreversible renal disease.

In reflux nephropathy both interstitial and glomerular damage advances with an increase in the scarring grade even in macroscopically normal regions. Based on various histologic findings, sclerosis and the enlargement of glomeruli rapidly accelerate between stages c-a and c-b, as shown by the combined Smellie's scarring grade of the bilateral kidneys. These two steep histologic changes in stage c-b are followed by a remarkable reduction in renal function (DTPA-GFR) and an increase in the amount of urinary protein. These clinicopathological changes thus suggest that hemodynamic changes or overloading in the functional remnant nephrons possibly start in stage c-a. It is also suggested that glomerular enlargement is an index of progressive disease in reflux nephropathy. Among our specimens, most cases of glomerular sclerosis were global while focal segmental glomerulosclerosis was very rare. These findings thus suggest that the global sclerosis observed in our specimens is clearly different from focal segmental glomerulosclerosis.

Course of Renal Pathology in Patients With Systemic Lupus Erythematosus

Evaluation of the course of lupus nephropathy by serial kidney biopsy in 50 patients revealed a complex pattern of transitions from one histologic class to another. A high rate of transformations (56 percent) was observed, with fewer than half the patients remaining in the original category. Although the general trend was towards transformation to a less severe lesion (WHO classes III and IV transforming into classes II and V), this was certainly not the rule for all individual classes. These transformations were rarely predictable on the basis of available clinical, laboratory, or pathologic information, and were less common in younger patients. These results help clarify the pathologic behavior of lupus nephropathy in the modern therapeutic era and highlight the value of pathologic examination for the planning and evaluation of therapy in selected patients.

Course of renal pathology in patients with systemic lupus erythematosus

Evaluation of the course of lupus nephropathy by serial kidney biopsy in 50 patients revealed a complex pattern of transitions from one histologic class to another. A high rate of transformations (56 percent) was observed, with fewer than half the patients remaining in the original category. Although the general trend was towards transformation to a less severe lesion (WHO classes III and IV transforming into classes II and V), this was certainly not the rule for all individual classes. These transformations were rarely predictable on the basis of available clinical, laboratory, or pathologic information, and were less common in younger patients. These results help clarify the pathologic behavior of lupus nephropathy in the modern therapeutic era and highlight the value of pathologic examination for the planning and evaluation of therapy in selected patients.

Immune complex glomerulonephritis and amyloidosis in Schistosoma japonicum infected rabbits

Epidemiologically, the incidence of renal pathology in patients with chronic parasitic infections is higher than expected. In particular, schistosomiasis may have an association with renal failure. 24 New Zealand White rabbits were, therefore infected with 250 or 500 Schistosoma japanicum cercariae of the Philippine-Leyte strain and studied for eight months to determine if rabbits with long-term infections were suitable hosts for the study of schistosomal nephropathy. Clinical evidence for renal disease consisted of proteinuria, haematuria, and casts. Of the 18 surviving infected animals, six had trace amounts of protein in their urine, three had significant proteinuria ranging from 100 to 300 mg%, four exhibited haematuria and 14 were positive for the presence of proteinaceous cast formation. The clinical findings correlated with the histological data. Periodic open renal biopsies on a subgroup of the animals revealed no changes until about the sixth month. At eight months after infection, five (28%) of the 18 rabbits had amyloid deposits and 15 (83%) had some degree of renal change which included mild focal, diffuse intracapillary, and crescentic glomerulonephritis with mesangial and subendothelial complex trapping. Periodic-acid Schiff staining graphically demonstrated wire loops and tubular casts. Immunofluorescence showed that 15 (83%) of the infected animals exhibited diffuse mesangial and peripheral capillary wall deposition of IgG while 14 contained IgM (78%). The third component of complement was found in only five (28%) of the infected rabbits. Parasite antigen could not be detected in the glomeruli of any of the animals. Kidneys from age-matched controls were within normal limits. Electron microscopy of glomeruli from several animals demonstrated the presence of subendothelial and mesangial immune complex deposition similar to that seen in systemic upus erythematosus. These findings show that schistosomiasis japonica in the rabbit offers an excellent model system for studying not only the renal pathology associated with human schistosomiasis but also the pathogenesis of amyloidosis which is a frequent sequela observed in a variety of chronic inflammatory infections.

Renal pathology in patients with rheumatoid arthritis.

We studied 76 patients with rheumatoid arthritis who had autopsies performed at the University of Utah and Salt Lake Veterans Administration Medical Center. The most common pathological finding in the kidney was interstitial fibrosis (46%) and internal proliferation of the arterioles in the absence of hypertension (54% of the cases). Renal amyloidosis was only found in 7% of the patients. Azotemia (creatinine above 2 mg/dl) was found in 9% of the patients but was not clinically significant. In addition uremia was not a frequent cause of death in patients with rheumatoid arthritis.

Renal abnormalities discovered by routine postangiography abdominal films

Patients with acquired heart disease undergoing angiocardiographic procedures had routine postangiographic abdominal films performed. In fifty-six consecutive cases with clinically unsuspected renal disease, three patients were found to have significant abnormalities. The not infrequent finding of clinically unsuspected renal pathology in patients undergoing angiographic procedures during the evaluation of acquired heart disease has led us to the recommendation that all patients have postangiographic abdominal films. This represents an inexpensive screening test for renal pathology with no increase in patient risk.