Figure 4 - available via license: Creative Commons Attribution 2.0 Generic
Content may be subject to copyright.
Source publication
Post-infectious glomerulonephritis (PIGN) usually occurs within few days to weeks following an infection. Clinical presentation is variable, but in general, it is considered a benign entity with good prognosis. It rarely requires kidney biopsy to confirm the diagnosis. We present a case of a 55-year-old, previously healthy, male who presented for w...
Context in source publication
Context 1
... day 7 of hospitalization, patient started to drop his urine output and by the ninth day, his creatinine has risen to 9.49 and he required hemodialysis. A decision to proceed with a core kidney biopsy was made. Results came back as diffuse endocapillary proliferative and exudative glomerulonephritis with infiltrating monocytes/macrophages 3+ and neutrophils 1+ on light microscopy (Fig. 4). Electron microscopy revealed global subendothelial electron dense deposits consisting of mixed cryoglobulin (IgG/IgM) and C3, segmental subepithe- lial deposits and intracapillary fibrillar fibrin (Fig. 5). Immu- nofluorescence (IF) revealed global glomerular capillary wall positivity for IgG, trace IgM, 2+ C3, 1-2+ C1, 3+ kappa and trace lambda (Fig. 6, 7). These findings were compatible with a diagnosis of cryoglobulinemic glomerulonephritis or an atypi- cal form of ...
Similar publications
Background:
Cryoglobulinemia is a cold-reactive autoimmune disease. It is of distinctive importance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass (CPB). Cryoglobulins, which activate at variable levels of hypothermia, can cause precipitation during surgery leading to possibly severe leukocytoclastic or necrotizing vas...
Citations
... Membranoproliferative GN is the commonest pathological type in Cryo GN, observed in 70% to 90% of cases. [2,11,[41][42][43][44] The rest are other types of proliferative GN, for example, endocapillary proliferative GN, mesangial proliferative GN, and rare crescentic GN. [21,[42][43][44][45][46][47] By light microscopy, there are some characteristics which can help distinguish proliferative Cryo GN from primary proliferative GN. Eosinophilic and periodic acid-Schiff stain (PAS)-strongly positive deposits in the sub-endothelial sites and within capillary lumens (socalled pseudothrombi or hyaline thrombi) often appear in Cryo GN; diffuse intra-capillary infiltration of massive monocytes/macrophages (in acute and chronic stages) and less polymorphonuclear leukocytes (in acute stage) are often observed in Cryo GN. [21,28,[42][43][44]48] By immune-fluorescence microscopy, there are granular immune deposits in mesangium and capillary wall, which often sketches a petal-like glomerular outline in the type of membranoproliferative GN. ...
Objective:
Cryoglobulinemia often causes systemic vasculitis, thereby damaging to skin and internal organs including kidneys, even life-threatening. This review aimed to introduce the advances in understanding, detection, and treatment of this disease in recent years, with a particular concern to clinical practice.
Data sources:
All the data in this review were from the English or Chinese literature in the PubMed and China National Knowledge Infrastructure databases as of March 2019.
Study selection:
This review selected important original articles, meaningful reviews, and some reports on cryoglobulinemia published in recent years and in history, as well as the guidelines for treatment of underlying diseases which lead to cryoglobulinemia.
Results:
Diagnosis of cryoglobulinemia relies on serum cryoglobulin test, in which to ensure that the blood sample temperature is not less than 37°C in the entire pre-analysis phase is the key to avoid false negative results. Cryoglobulinemic vasculitis (Cryo Vas), including cryoglobulinemic glomerulonephritis (Cryo GN), usually occurs in types II and III mixed cryoglobulinemia, and can also be seen in type I cryoglobulinemia caused by monoclonal IgG3 or IgG1. Skin purpura, positive serum rheumatoid factor, and decreased serum levels of C4 and C3 are important clues for prompting types II and III Cryo Vas. Renal biopsy is an important means for diagnosis of Cryo GN, while membranous proliferative GN is the most common pathological type of Cryo GN. In recent years, great advances have been made in the treatment of Cryo Vas and its underlying diseases, and this review has briefly introduced these advances.
Conclusions:
Laboratory examinations of serum cryoglobulins urgently need standardization. The recent advances in the diagnosis and treatment of Cryo Vas and GN need to be popularized among the clinicians in related disciplines.
