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Conti S, Remuzzi G, Benigni A, Tomasoni S. Imaging the Kidney with an Unconventional Scanning Electron Microscopy Technique: Analysis of the Subpodocyte Space in Diabetic Mice. Int J Mol Sci 2022; 23:ijms23031699. [PMID: 35163622 PMCID: PMC8836024 DOI: 10.3390/ijms23031699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 02/04/2023] Open
Abstract
Transmission electron microscopy (TEM) remains the gold standard for renal histopathological diagnoses, given its higher resolving power, compared with light microscopy. However, it imposes several limitations on pathologists, including longer sample preparation time and a small observation area. To overcome these, we introduced a scanning electron microscopy (SEM) technique for imaging resin-embedded semi-thin sections of renal tissue. We developed a rapid tissue preparation protocol for experimental models and human biopsies which, alongside SEM digital imaging acquisition of secondary electrons (SE–SEM), enables fast electron microscopy examination, with a resolution similar to that achieved by TEM. We used this unconventional SEM imaging approach to investigate the subpodocyte space (SPS) in BTBR ob/ob mice with type 2 diabetes. Analysis of semi-thin sections with secondary electrons revealed that the SPS had expanded in volume and covered large areas of the glomerular basement membrane, forming wide spaces between the podocyte body and the underlying filtering membrane. Our results show that SE–SEM is a valuable tool for imaging the kidney at the ultrastructural level, filling the magnification gap between light microscopy and TEM, and reveal that in diabetic mice, the SPS is larger than in normal controls, which is associated with podocyte damage and impaired kidney function.
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[The relevance of electron microscopy in kidney biopsies to 21 st century pathology]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2021; 54:234-241. [PMID: 34544553 DOI: 10.1016/j.patol.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/18/2020] [Accepted: 01/20/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Electron microscopy (EM) has been used in the study of renal biopsies for more than 5 decades; however, it is expensive and the possibility of restricting it to selected cases has been considered. This study aims to reevaluate the necessity for EM in the diagnosis of renal biopsies today. MATERIAL AND METHODS All renal biopsies taken between 2016 and 2019 with adequate light microscopy (LM), immunofluorescence (IF) and EM studies were included. The initial diagnosis (without EM) and the final diagnosis (with EM) was recorded. EM was considered necessary in cases in which the initial and final diagnoses did not concur, when diagnosis could not be made with LM and IF only or if the EM study revealed further clinically relevant findings. RESULTS A total of 621 biopsies were included, 498 (80.2%) of native kidneys and 123 (19.8%) of transplanted kidneys. In 115 cases (18.5%) EM had been deemed necessary for diagnosis; it was required more frequently in hereditary diseases (96.8%) and isolated hematuria (88.9%) but less often in nephrotic syndrome (6.7%) and renal transplant biopsy (5.7%) (p < 0.001). CONCLUSIONS EM was required in less than a fifth of renal biopsies, being more necessary in isolated hematuria and hereditary diseases and less so in nephrotic syndrome and in renal graft biopsies. These findings may prove useful as a guide to case selection protocols in which EM could be considered as a non-mandatory technique.
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Dittmayer C, Goebel HH, Heppner FL, Stenzel W, Bachmann S. Preparation of Samples for Large-Scale Automated Electron Microscopy of Tissue and Cell Ultrastructure. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2021; 27:815-827. [PMID: 34266508 DOI: 10.1017/s1431927621011958] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Manual selection of targets in experimental or diagnostic samples by transmission electron microscopy (TEM), based on single overview and detail micrographs, has been time-consuming and susceptible to bias. Substantial information and throughput gain may now be achieved by the automated acquisition of virtually all structures in a given EM section. Resulting datasets allow the convenient pan-and-zoom examination of tissue ultrastructure with preserved microanatomical orientation. The technique is, however, critically sensitive to artifacts in sample preparation. We, therefore, established a methodology to prepare large-scale digitization samples (LDS) designed to acquire entire sections free of obscuring flaws. For evaluation, we highlight the supreme performance of scanning EM in transmission mode compared with other EM technology. The use of LDS will substantially facilitate access to EM data for a broad range of applications.
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Affiliation(s)
- Carsten Dittmayer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neuropathology, Charitéplatz 1, 10117Berlin, Germany
| | - Hans-Hilmar Goebel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neuropathology, Charitéplatz 1, 10117Berlin, Germany
- Johannes-Guttenberg University, Department of Neuropathology, Langenbeckstraße 1, 55122Mainz, Germany
| | - Frank L Heppner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neuropathology, Charitéplatz 1, 10117Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Neurocure Cluster of Excellence, Charitéplatz 1, 10117Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Werner Stenzel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neuropathology, Charitéplatz 1, 10117Berlin, Germany
| | - Sebastian Bachmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Functional Anatomy, Charitéplatz 1, 10117Berlin, Germany
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Valente S, Comai G, Malvi D, Corradetti V, La Manna G, Pasquinelli G. Recovering histological sections for ultrastructural diagnosis of glomerular diseases through the pop-off technique. J Nephrol 2021; 34:2085-2092. [PMID: 33929691 DOI: 10.1007/s40620-021-01043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Electron microscopy (EM) represents an indispensable technique for the diagnosis of kidney glomerular diseases. When dedicated tissue is not available, histological and cryostat sections can be reprocessed for EM using the pop-off technique. Here the practical value of this technique is analysed with emphasis on its accuracy in measuring basement membrane thickness and detecting immune deposits. METHODS Ninety-four histological sections of kidney tissues fixed in Serra's solution, stained with H&E, PAS, and Masson's Trichrome; for EM analysis, the sections were recovered from either treated or untreated microscope slides through the pop-off technique. Some sections were recovered from cryosections allocated for immunofluorescence. RESULTS The ultrastructural details were sufficiently maintained on tissues fixed with Serra's solution despite being considered disadvantageous for EM. The type of microscope slides and the time of biopsy storage did not affect the quality of section recovery. The histological stains had only moderate effects on the electron-density of the glomerular basement membrane (GBM). The pop-off technique reduced the GBM thickness when compared to the conventional EM processing but preserved the electron density of immune deposits. CONCLUSIONS The application of the pop-off method to renal biopsy is a useful recovery method that produces limited but satisfactory results when there is no suitable material for EM. The ultrastructural morphology was retained even from tissues fixed with Serra's solution, and deposits maintained the expected electron density, however, we observed an overall thickness reduction of the GBM that could have a potential impact on thin membrane disease diagnosis.
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Affiliation(s)
- Sabrina Valente
- Biotechnology and Methods in Laboratory Medicine, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.
| | - Giorgia Comai
- Nephrology, Dialysis and Kidney Transplantation Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Deborah Malvi
- Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valeria Corradetti
- Nephrology, Dialysis and Kidney Transplantation Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Kidney Transplantation Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gianandrea Pasquinelli
- Biotechnology and Methods in Laboratory Medicine, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.,Subcellular Nephro-Vascular Diagnostic Program, Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Sinha A, Bagga A, Banerjee S, Mishra K, Mehta A, Agarwal I, Uthup S, Saha A, Mishra OP. Steroid Sensitive Nephrotic Syndrome: Revised Guidelines. Indian Pediatr 2021. [PMID: 33742610 PMCID: PMC8139225 DOI: 10.1007/s13312-021-2217-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Justification Steroid sensitive nephrotic syndrome (SSNS) is one of the most common chronic kidney diseases in children. These guidelines update the existing Indian Society of Pediatric Nephrology recommendations on its management. Objective To frame revised guidelines on diagnosis, evaluation, management and supportive care of patients with the illness. Process The guidelines combine evidence-based recommendations and expert opinion. Formulation of key questions was followed by review of literature and evaluation of evidence by experts in two face-to-face meetings. Recommendations The initial statements provide advice for evaluation at onset and follow up and indications for kidney biopsy. Subsequent statements provide recommendations for management of the first episode of illness and of disease relapses. Recommendations on the use of immunosuppressive strategies in patients with frequent relapses and steroid dependence are accompanied by suggestions for step-wise approach and plan of monitoring. Guidance is also provided regarding the management of common complications including edema, hypovolemia and serious infections. Advice on immunization and transition of care is given. The revised guideline is intended to improve the management and outcomes of patients with SSNS, and provide directions for future research.
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Affiliation(s)
- Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr. Arvind Bagga, Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
| | | | - Kirtisudha Mishra
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Amarjeet Mehta
- Department of Pediatrics, Sawai Man Singh Medical College, Jaipur, India
| | - Indira Agarwal
- Department of Pediatrics, Christian Medical College, Vellore, India
| | - Susan Uthup
- Department of Pediatrics, Trivandrum Medical College, Thiruvananthapuram, India
| | - Abhijeet Saha
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Om Prakash Mishra
- Department of Pediatrics, Institute of Medical Sciences, Benaras Hindu University, Varanasi, India
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Howell DN, Herrera GA. Electron microscopy in renal pathology: overall applications and guidelines for tissue, collection, preparation, and stains. Ultrastruct Pathol 2020; 45:1-18. [PMID: 33320036 DOI: 10.1080/01913123.2020.1854407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Electron microscopy is a mainstay in the analysis of renal biopsies, where it is typically employed in a correlative fashion along with light and immunofluorescence microscopy. Despite the development of a growing armamentarium of molecular and biochemical analytic methods as well as new immunostains with a widening panel of immunoreactants, electron microscopy remains crucial to the diagnosis of a number of disorders involving the renal glomerulus, vasculature, and tubulointerstitial compartment. The number of renal biopsies continues to grow and the indications for these biopsies continue expanding together with our understanding of disease processes. Proper collection of biopsies and careful analysis of data emanating from diagnostic modalities, clinical information, imaging, gross and microscopic tissue analysis, including a wide range of ancillary studies, represent the essential paradigm for generating detailed diagnoses with clinical significance. This communication offers a guide to the pre-analytic and analytic process for renal biopsy examination, discusses diagnostic keys and pitfalls for an important category of renal diseases (immune complex disorders), and provides an introduction to a useful adjunct diagnostic method (ultrastructural immunolabeling). Renal pathologists should render expert diagnoses that guide patient management, provide prognostic information and lead to targeted new therapeutic interventions that are currently available.
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Affiliation(s)
- David N Howell
- Department of Pathology, Duke University and Durham Veterans Affairs Medical Centers, Durham, NC, USA
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Dittmayer C, Völcker E, Wacker I, Schröder RR, Bachmann S. Modern field emission scanning electron microscopy provides new perspectives for imaging kidney ultrastructure. Kidney Int 2019; 94:625-631. [PMID: 30143069 DOI: 10.1016/j.kint.2018.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/09/2018] [Accepted: 05/17/2018] [Indexed: 11/30/2022]
Abstract
Recent progress in electron microscopy (EM) techniques has opened new pathways to study renal tissue in research and pathology. Modern field emission scanning EM may be utilized to scan thin sections of resin-embedded tissue mounted on a conductive support. Here we sought to achieve automated imaging without the typical limitations of transmission EM with equivalent or superior quality. Extended areas of tissue were either imaged in two (nanotomy) or in three dimensions (volume EM) by serial-section-based array tomography. Single-beam and fast-recording multi-beam field emission scanning EM instruments were compared using perfusion-fixed rodent kidneys. High-resolution scans produced excellent images of tissue, cells, and organelles down to macromolecular complexes. Digital stitching of image tiles in both modes allowed seamless Google Earth-like zooming from overview to regions of interest at the nanoscale. Large datasets were created that can be rapidly shared between scientists of different disciplines or pathologists using open source software. Three-dimensional array tomography of thin sections was followed by segmentation to visualize selected features in a large volume. Furthermore, correlative light-EM enabled the identification of functional information in a structural context. Thus, limitations in biomedical transmission EM can be overcome by introducing field emission scanning EM-based technology that permits high-quality, large field-of-view nanotomy, volume EM, and correlative light-EM modes. Advantages of virtual microscopy in clinical and experimental nephrology are illustrated.
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Affiliation(s)
- Carsten Dittmayer
- Department of Anatomy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Irene Wacker
- Centre for Advanced Materials, University of Heidelberg, Heidelberg, Germany
| | - Rasmus R Schröder
- Centre for Advanced Materials, University of Heidelberg, Heidelberg, Germany; BioQuant, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Bachmann
- Department of Anatomy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Association of podocyte autophagosome numbers with idiopathic membranous nephropathy and secondary membranous nephropathy. Int Urol Nephrol 2017; 49:1025-1031. [PMID: 28285376 DOI: 10.1007/s11255-017-1555-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE This study was to investigate the relation between the number of autophagosomes in podocytes and the syndromes of idiopathic membranous nephropathy (IMN) and secondary membranous nephropathy (sMN). METHODS The pathological changes in the kidney tissues of patients were detected with the hematoxylin and eosin staining, the periodic acid-Schiff reagent treatment, the Masson's trichrome staining and the immunofluorescence detection (IF). Meanwhile, the autophagosomes in podocyte were analyzed by transmission electron microscopy and the IF assay pointing to LC3-II, an autophagic marker. Clinical data, including age, sex, edema, serum creatinine, estimated glomerular filtration rate, hematuria, urine protein excretion and serum albumin, were collected from in-patient medical records. Finally, the association of podocyte autophagosome numbers with idiopathic membranous nephropathy and secondary membranous nephropathy was studied. RESULTS Fewer autophagosomes were observed in podocytes of nephropathy group compared with the control group. Moreover, there was a significant difference in the autophagosome number between the two types of MN and each kind of nephropathy demonstrated distinct characteristics. Although the reduced autophagosome number in the IMN cases was not related to sex, this trend was exacerbated along with the progression from pathological stage I to II. In contrast, fewer autophagosomes were observed in class II and V LN patients compared with the controls, while greater numbers were detected in class III and IV LN patients. CONCLUSIONS The results indicated that the autophagy participated in the podocyte injury in IMN and sMN and the number of autophagosomes in podocytes was related to the pathological classification.
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Dittmayer C, Völcker E, Wacker I, Schröder R, Bachmann S. Scanning electron microscopy of thin sections: A technique to overcome limitations in kidney ultrastructural research. Ultrastruct Pathol 2017. [DOI: 10.1080/01913123.2016.1272165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Irene Wacker
- Centre for Advanced Material, Universität Heidelberg, Heidelberg, Germany
| | - Rasmus Schröder
- Centre for Advanced Material, Universität Heidelberg, Heidelberg, Germany
- Cryo EM, Cell Networks, Bioquant, University Hospital Heidelberg, Heidelberg, Germany
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Liang S, Jin J, Gong J, Lin B, Li Y, He Q. How many podocyte autophagosomes are there in immunoglobulin A nephropathy and idiopathic membranous nephropathy? Int Urol Nephrol 2016; 48:2109-2114. [PMID: 27580730 DOI: 10.1007/s11255-016-1398-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to investigate the number of autophagosomes in podocyte from kidney tissue of immunoglobulin A nephropathy (IgAN) and idiopathic membranous nephropathy (IMN). METHODS The changes in kidney tissue pathology were detected after hematoxylin and eosin, periodic acid-Schiff, Masson's trichrome and immunofluorescence. The autophagosomes of podocyte were analyzed by transmission electron microscopy. Clinical data, including age, gender, edema, serum creatinine, estimated glomerular filtrating rate (eGFR), hematuria, urine protein excretion and serum albumin, were collected from inpatient medical record. RESULTS It was found that the number of autophagosomes in podocyte of nephropathy group was lower when compared to the control group. At the same time, we did not find the difference of the parameter between these two kinds of nephropathy. Further study showed that the index was affected by two factors: eGFR and gender. The cases with worse eGFR (eGFR < 60 ml/min) and male patients presented more autophagosomes. Furthermore, each nephropathy had its own character. The phenomena of reduced autophagosomes were found in IMN cases, did not change from male to female, and further aggravated from pathological stage I to II. By contrast, IgAN cases with less eGFR exhibited more autophagosomes. CONCLUSIONS Therefore, the results of the present study indicate that autophagy participates in podocyte injury and the progression of IgAN and IMN.
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Affiliation(s)
- Shikai Liang
- Department of Nephrology, Zhejiang Provincial People's Hospital, Zhejiang, 310014, People's Republic of China
| | - Juan Jin
- Department of Nephrology, Zhejiang Provincial People's Hospital, Zhejiang, 310014, People's Republic of China
| | - Jianguang Gong
- Department of Nephrology, Zhejiang Provincial People's Hospital, Zhejiang, 310014, People's Republic of China
| | - Bo Lin
- Department of Nephrology, Zhejiang Provincial People's Hospital, Zhejiang, 310014, People's Republic of China
| | - Yiwen Li
- Department of Nephrology, Zhejiang Provincial People's Hospital, Zhejiang, 310014, People's Republic of China
| | - Qiang He
- Department of Nephrology, Zhejiang Provincial People's Hospital, Zhejiang, 310014, People's Republic of China.
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Tewari R, Nada R, Rayat CS, Boruah D, Dudeja P, Joshi K, Sakhuja V. Correlation of proteinuria with podocyte foot process effacement in IgA nephropathy: an ultrastructural study. Ultrastruct Pathol 2014; 39:147-51. [PMID: 25268180 DOI: 10.3109/01913123.2014.960543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Proteinuria is an uncommon clinical manifestation of IgA nephropathy and is usually seen in cases with severe lesions like endocapillary proliferation. However, it is occasionally seen even with cases with mild glomerular manifestations and may even be of nephrotic range. PREDICTOR Podocyte foot process effacement. OUTCOME Severity of proteinuria. MEASUREMENTS Podocyte foot process effacement was measured. Morphometric analysis was performed on transmission electron microscope images using a computerized digital photomicrograph system (BioWizard 4.2 Image analysis software, New Delhi, India). Proteinuria was measured quantitatively assigned into five grades. RESULTS It was found that as the extent of proteinuria increased, the effacement ratio also increased, and this was most significant between "no" proteinuria and the rest of the categories. CONCLUSION Nephrotic presentation in IgA nephropathy is a known phenomenon and in certain cases may show near normal glomerular morphology with severe foot process effacement on EM being the only significant finding to explain the proteinuria. Proteinuria in these cases shows a significant correlation with degree of foot process effacement. Renal biopsy is important in these cases because they are known to have a better prognosis and are usually steroid responsive.
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Affiliation(s)
- Rohit Tewari
- Department of Pathology, Armed Forces Medical College , Pune, Maharashtra , India
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