1. count all glomeruli, determine the number of sclerotic glomeruli
DESCRIPTION
1. Count all glomeruli, determine the number of sclerotic glomeruli. Normal renal cortex. H&E. Normal Glomerulus. Normal Glomerulus. GLOBAL SCLEROSIS (PAS). Glomerular obsolescence (count as sclerotic). SEGMENTAL SCLEROSIS (PAS). Should be rare in Loop biopsies. - PowerPoint PPT PresentationTRANSCRIPT
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1. Count all glomeruli, determine the number of sclerotic glomeruli
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Normal renal cortex. H&E
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Normal Glomerulus
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Normal Glomerulus
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GLOBAL SCLEROSIS (PAS)
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Glomerular obsolescence (count as sclerotic)
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SEGMENTAL SCLEROSIS (PAS)
Should be rare in Loop biopsies
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Mesangial expansion, hypercellularity
You can note it but not important if mild
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Nodular mesangial sclerosis (PAS)
Means that the donor was diabetic. Should be noted, very rarely occurs
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Glomerular capillary microthrombi (Trichrome)
Glomeruli fibrin thrombi are common in brain trauma; they indicate donor DIC.Report it, but these thrombi go away quickly in the recipient
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2. Estimate degree of interstitial fibrosis
• Mild: up to 25% of cortex (do not consider medulla)
• Moderate 25-50% of cortex• Severe: Over 50%
• Note inflammation (usually mild and patchy in fibrotic areas), if present
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Severe interstitial fibrosis (right side is intact)
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This entire area is fibrotic
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3. Examine vasculature• Note arteriolar hyalin• Note intimal thickening
– Mild: if less than thickness of the media– Moderate: Thicker than the media– Severe: More than twice the thickness of the media
with luminal narrowing• Note severe obliterative intimal thickening
(usually kidney will be discarded• Note arterial/arteriolar thrombi – Thrombotic
microangiopathy (TMA) – rare in donors but bad
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Normal arteriole
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Severe arteriolar hyalin
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Normal intrarenal artery
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Intimal thickening
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Thrombotic microangiopathy with luminalobliteration
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TMA with obliterated lumen and fragmented RBCs
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TMA with severe mucoid thickening of a small artery
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Conclusions
• Do not give diagnosis• Be descriptive• Acute tubular necrosis (ATN) is common
in loop biopsies. If severe, you can comment on it (prominently thin tubular epithelium, lots of debris in tubular lumina) but it is reversible and if not striking do not mention it