SHARPENING GLOMERULONEPHRITIS DIAGNOSIS WITH ELECTRON MICROSCOPE: CASE REPORTS

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https://storage.unitedwebnetwork.com/files/1099/ea662b5de09160df4217c951ca3335c8.pdf

Abstract Title

First Name *

Voon Ken

Last Name *

Fong

Co-author 1

Shing Shen Bay Victorbayss@gmail.com Hospital UKM Nephrology Kuala Lumpur

Co-author 2

Muhammad Yusuf Abu Shamsi ngocop84@gmail.com Hospital UKM Nephrology Kuala Lumpur

Co-author 3

Lydia Kamaruzaman lydia83@gmail.com Hospital UKM Nephrology Kuala Lumpur

Co-author 4

Ruslinda Mustafar ruslinda.m@gmail.com Hospital UKM Nephrology Kuala Lumpur

Co-author 5

Wan Syahira Ellani Wan Ahmad Kammal ellani@ppukm.ukm.edu.my Hospital UKM Pathology Kuala Lumpur

Co-author 6

Nordashima Abd Shukor nordashima@ppukm.ukm.edu.my Hospital UKM Pathology Kuala Lumpur

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Electron microscopic (EM) examination is essential in evaluating renal biopsies. While a definitive diagnosis can sometimes be confirmed by light (LM) and immunofluorescence (IF) microscopy, EM can be helpful and diagnostic in some instances. Nevertheless, EM is still underused in lower and middle-income countries due to limited resources.

Methods

We aim to report 2 cases in which EM provides a different diagnosis and alters our management.

Results

Case Presentation

Laboratory investigation

LM and IF examination

EM examination

A 82-year-old patient with hypertension, chronic kidney disease (CKD) and atrial fibrillation on anticoagulant presented with acute kidney injury with nephrotic syndrome.

Scr: 164 μmol/l
(from 130 μmol/l)
Alb: 28 g/l
ESR: 48 mm/hr
No plasma cells in blood film
C3/C4: Normal
Infective screening: Normal
anti-PLA2r: Normal
Serum FLC Kappa/Lambda ratio 1.98
(Range 0.54 - 3.30)

UFEME: No RBC
UPCI: 0.35 g/mmol
No urine and serum paraprotein detected

13 glomeruli with 5 global sclerosis. The viable glomeruli show mesangial matrix expansion and mild mesangial hypercellularity with double contouring of the capillary basement membrane.

Congo red stain negative

IF:
IgG (2+, capillary and mesangium)
C3 (3+, capillary and mesangium)

IgA (+/-)

IgM (1+)

Kappa (2+, focal)

Lambda (3+)

Impression:
Mesangio-proliferative glomerulonephritis with immune deposits

Indistinct, electron-dense areas within the glomerular basement membrane and the mesangium.

Conclusions

These cases beautifully illustrate the important roles of EM in the evaluation of renal biopsy and EM should be included as part of the examination.

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