Minimal change disease immunohistology: Difference between revisions
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==Overview== | ==Overview== | ||
A kidney [[biopsy]] is not routinely performed as soon as nephrotic syndrome is found during lab work-up. According to the National Kidney Foundation (NKF) Kidney Disease – Improve Global Outcomes (KDIGO) guidelines in 2012, | A kidney [[biopsy]] is not routinely performed as soon as nephrotic syndrome is found during lab work-up. According to the National Kidney Foundation (NKF) Kidney Disease – Improve Global Outcomes (KDIGO) guidelines in 2012, an initial attempt using corticosteroids should be performed before a renal biopsy is performed. A renal biopsy of minimal change disease shows no or minimal abnormalities on light microscopy. Lipid-laden cells may be seen in proximal tubular [[epithelium]]. Renal biopsy is often unremarkable under [[immunofluorescence]], with the exception of few cases that stain positively for [[IgM]] antibodies and [[C3]].The hallmark of minimal change disease is absence of visible alterations on light microscopy and absence of effacement of foot processes by electron microscopy. | ||
==Immunohistology== | ==Immunohistology== | ||
===Light Microscopy=== | ===Light Microscopy<ref name="pmid23871408">{{cite journal| author=Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH et al.| title=KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis. | journal=Am J Kidney Dis | year= 2013 | volume= 62 | issue= 3 | pages= 403-41 | pmid=23871408 | doi=10.1053/j.ajkd.2013.06.002 |pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871408 }} </ref>=== | ||
A renal biopsy of minimal change disease shows no abnormalities on light microscopy. Lipid-laden cells may be seen in proximal tubular epithelium. Additional features of [[focal segmental glomerulosclerosis]], such as [[mesangial]] prominence, interstitial [[fibrosis]], and tubular atrophy, or glomerular tip lesions of [[focal segmental glomerulosclerosis]], may be seen in patients who have complicated disease.<ref name="pmid12704572">{{cite journal| author=D'Agati V| title=Pathologic classification of focal segmental glomerulosclerosis. | journal=Semin Nephrol | year= 2003 | volume= 23 | issue= 2 |pages= 117-34 | pmid=12704572 | doi=10.1053/snep.2003.50012 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12704572 }} </ref> Those with acute renal injury may have histological features of focal flattening of the proximal tubular epithelium.<ref name="pmid12704572">{{cite journal| author=D'Agati V| title=Pathologic classification of focal segmental glomerulosclerosis. | journal=Semin Nephrol | year= 2003 |volume= 23 | issue= 2 | pages= 117-34 | pmid=12704572 | doi=10.1053/snep.2003.50012 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12704572 }} </ref> | * A renal biopsy of minimal change disease shows no abnormalities on light microscopy. | ||
* Lipid-laden cells may be seen in proximal tubular epithelium. | |||
* Additional features of [[focal segmental glomerulosclerosis]], such as [[mesangial]] prominence, interstitial [[fibrosis]], and tubular atrophy, or glomerular tip lesions of [[focal segmental glomerulosclerosis]], may be seen in patients who have complicated disease.<ref name="pmid12704572">{{cite journal|author=D'Agati V| title=Pathologic classification of focal segmental glomerulosclerosis. |journal=Semin Nephrol | year= 2003 | volume= 23 | issue= 2 | pages= 117-34 | pmid=12704572 |doi=10.1053/snep.2003.50012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12704572 }} </ref> | |||
* Those with acute renal injury may have histological features of focal flattening of the proximal tubular epithelium.<ref name="pmid12704572">{{cite journal| author=D'Agati V| title=Pathologic classification of focal segmental glomerulosclerosis. | journal=Semin Nephrol | year= 2003 |volume= 23 | issue= 2 | pages= 117-34 | pmid=12704572 | doi=10.1053/snep.2003.50012 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12704572 }} </ref> | |||
===Immunofluorescence=== | ===Immunofluorescence=== | ||
Renal biopsy is often unremarkable under [[immunofluorescence]], with the exception of few cases that stain positively for [[IgM]] antibodies and [[C3]].<ref name="pmid12704572">{{cite journal|author=D'Agati V| title=Pathologic classification of focal segmental glomerulosclerosis. |journal=Semin Nephrol | year= 2003 | volume= 23 | issue= 2 | pages= 117-34 | pmid=12704572 |doi=10.1053/snep.2003.50012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12704572 }} </ref> | * Renal biopsy is often unremarkable under [[immunofluorescence]], with the exception of few cases that stain positively for [[IgM]] antibodies and [[C3]].<ref name="pmid12704572">{{cite journal|author=D'Agati V| title=Pathologic classification of focal segmental glomerulosclerosis. |journal=Semin Nephrol | year= 2003 | volume= 23 | issue= 2 | pages= 117-34 | pmid=12704572 |doi=10.1053/snep.2003.50012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12704572 }} </ref> | ||
==References== | ==References== |
Revision as of 16:09, 5 June 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
A kidney biopsy is not routinely performed as soon as nephrotic syndrome is found during lab work-up. According to the National Kidney Foundation (NKF) Kidney Disease – Improve Global Outcomes (KDIGO) guidelines in 2012, an initial attempt using corticosteroids should be performed before a renal biopsy is performed. A renal biopsy of minimal change disease shows no or minimal abnormalities on light microscopy. Lipid-laden cells may be seen in proximal tubular epithelium. Renal biopsy is often unremarkable under immunofluorescence, with the exception of few cases that stain positively for IgM antibodies and C3.The hallmark of minimal change disease is absence of visible alterations on light microscopy and absence of effacement of foot processes by electron microscopy.
Immunohistology
Light Microscopy[1]
- A renal biopsy of minimal change disease shows no abnormalities on light microscopy.
- Lipid-laden cells may be seen in proximal tubular epithelium.
- Additional features of focal segmental glomerulosclerosis, such as mesangial prominence, interstitial fibrosis, and tubular atrophy, or glomerular tip lesions of focal segmental glomerulosclerosis, may be seen in patients who have complicated disease.[2]
- Those with acute renal injury may have histological features of focal flattening of the proximal tubular epithelium.[2]
Immunofluorescence
- Renal biopsy is often unremarkable under immunofluorescence, with the exception of few cases that stain positively for IgM antibodies and C3.[2]
References
- ↑ Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH; et al. (2013). "KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis". Am J Kidney Dis. 62 (3): 403–41. doi:10.1053/j.ajkd.2013.06.002. PMID 23871408.
- ↑ 2.0 2.1 2.2 D'Agati V (2003). "Pathologic classification of focal segmental glomerulosclerosis". Semin Nephrol. 23 (2): 117–34. doi:10.1053/snep.2003.50012. PMID 12704572.