case 8 - esp-congress.org · s-anca (anti neutrofil cytoplasm antibodies) anti-mieloperossidase...
Post on 23-May-2019
216 Views
Preview:
TRANSCRIPT
Case 8
Enterprise | Interest
None
Clinical data
Renal biopsy
27 year old moroccan man
case history: negative before recovery due to edema of legs connected with inflammatory respiratory symptoms
and nephrotic syndrome; no family history of renal or autoimmune diseases
Laboratory data:
serum creatinine 1,07 mg/dL (0,67-1,17)
s-urea 54 mg/dL (18-45)
proteine urine 24h 19,73 g/24h (0,00-0,15)
HBV, HCV, quantiferon test: negative
LM EM
S-ANA (IFA su Hep-2) negative;
S-ANTI ENA screening test for SS-A(Ro52 e Ro60), SS-B, Sm, RNP, Jo-1, Scl-70 negative
S-ANCA (IFA) absent;
S-ANCA (Anti neutrofil cytoplasm antibodies) anti-mieloperossidase (MPO) (method CLIA) negative
S-ANCA. anti -Proteinasi 3 (PR-3) ( method CLIA) negative
SLE panel autoantibodies:
LM
suggesting a membranoproliferative glomerunephritis
lobulated glomerular tuft
thickened GBMs
endocapillary hypercellularity
mesangial proliferation
no tubular, vascular or interstitial injuries
H&E
PAS PAS
MAS TRI
IF
IgG IgA
C1qC3c C4c
Glomerular intense stain
IgG, IgM, C3c, C4c, C1q, light chains kappa and lambda, fibrinogen
type I membranoproliferative glomerunephritis
TEM
tolouidine blue thick section subepithelial, subendothelial, intramembranous and mesangial electrondense deposits
featuring a probable Lupus Nephritis
Parallel linear deposits?
GNMP
with atypical deposits
To date the follow up is negative
•late onset and seropositivity of SLE
20032003
2010
potential subset of
“Lupus like” Nephritis
• LN by EM
• no clinical or serological signs of SLE
• no evidence of TRI
Lupus Nephritis
EM substructure deposits:
• fingerprint
• parallel linear arrays
• tubulofibrillar
2017
EM role
- to prove the localization of immune deposits
- to point out the specific substructure of immune deposits
- to compare and discern between similar morphologic deposit pattern
- to improve the challenging of differential diagnosis
Thank you for your attention!
top related