20. LUPUS NEPHRITIS
■ INDICATION FOR BIOPSY:
Newly detected lupus nephritis-24
Proteinuric relapse-7
refractory lupus nephritis-5
chronic kidney disease-3
Proteinuric relapse:
5 patients class IV IV (A+C)-2
IV (A)+V-3
1 Patient class IV+V IV(A+C) + V
1 Patient class III V
Among 5 refractory lupus nephritis only one patient had class switch from
IV(A)IV(A) +V
21. LUPUS NEPHRITIS
■ Full house pattern- 35 (89.7%)
■ At least one crescent in biopsy-13(33.3%)
■ Crescentic GN- 2
■ TMA-1
26. IRGN
■ 40% patients had atleast one crescent.
■ Crescentic GN was observed in 2 patient.
■ 24 % were diabetic and out of 6 patients 4 had co-existing diabetic nephropathy.
■ Most common differential diagnosis was SLE followed by C3GN.
■ Cellulitis was the most common documented infection.
■ IFTA: 0-25%- 24%
25-50%-12%
50-75%-4%
NO IFTA-60%
48. CKD-U
■ 7 patients had hypertension with severe arteriosclerosis
■ 1 patient had diabetes for 3 years.
■ 3 patients were non hypertensive.
■ 1 patient had renal failure during first pregnancy with cystically dilated medullary
tubules.
52. ACUTE TUBULAR INJURY
■ Pigment cast in 2 patients-myoglobin stain negative in one patient.
■ Fever with AKI-3 patients.
■ 1 patient had RVD with on ATT & ART.
58. ANTI-GBM
■ Atypical Anti-GBM:
case 1: TMA with linear IgA staining.
case 2:indolent course-creatinine stabilized at 1.9 mg/dl
case 3: presented as renal failure unclassified-CKD with moderate IFTA.
Segmental fibrinoid necrosis in 2 patients.
65. Renal cortical necrosis
■ 3 patients
Case1: 16/M had RTA-presented with anuric failure-cortical necrosis-entire cortex and
medulla coagulative necrosis. CT renal angio-normal .Cause –unknown.
Case 2: 25/F presented with postpartum AKI. 40-50% cortex necrotic.
Case3 : 50/M , snake bite-AKI- >75% cortex necrotic.large areas of haemorrhage in
necrotic interstitum.
66. Collapsing GN
CASE1 : 30/M with recurrent episodes of macroscopic hematuria and polyarthirits.
Renal failure with nephrotic proteinuria.C3(2+) non specific staining over glomerular
tuft. ? Parvovirus / still’s disease.
CASE 2: 58/M , presented with nephrotic syndrome with AKI.segmental staining of C3
in one glomerulus.
67. C3GN/DDD
CASE 1: 17/m , presented with nephrotic syndrome and normal renal function.
LM-MPGN. IF- C3 granular to pseudolinear positivity over capillary loops and
mesangium.
CASE 2: 47/F , presented with nephrotic syndrome with normal renal function.
85. ABMR
■ All cases associated with borderline ACR but not satisfying Mixed rejection.
■ ALL cases were C4d +
2
17
0
2
4
6
8
10
12
14
16
18
EARLY ABMR LATE ABMR
86. Glomerular disease in graft
■ IgA nephropathy-4
■ Superimposed ANCA/Anti-GBM disease in a combined ACR+ABMR-1
■ Post transplant FSGS-1