Histologic changes: The biopsy of the kidney shows a lesion represented between the two arrows at the right.

What is this lesion?

What is its histologic significance?

What is present in the renal tubule indicated by the arrow at the left?

Answer

What is the patient's diagnosis given this lesion and the lesions in the lung?

Clinical summary Discussion

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Answer

What is this lesion? Crescentic glomerulonephritis

What is its histologic significance? It means that a severe glomerulonephritis is present. Some of the cells in the compressed glomerulus next to the crescent are PMNs

What is present in the renal tubule? RBCs. This is the beginning of a red blood cell cast.

 

Crescents develop in cases of severe glomerulonephritis, in which inflammation spills over into Bowman's space and elicits proliferation of epithelium of the capsule. The inflammation impairs glomerular filtration, and RBCs and protein leak into the renal tubules. Red cell casts develop. The diagnosis of type of glomerulonephritis is based on the presence or absence of immune deposits by immunofluorescence or electron microscopy and includes glomerulonephritis caused by post infectious etiologies, lupus erythematosus, anti-glomerular basement membrane disease, Wegener's granulomatosis, microscopic polyangiitis, and idiopathic pauci-immune glomerulonephritis. In this patient no immune deposits were found by immunofluorescent staining. Electron microscopy was not performed.

What is the patient's diagnosis given this lesion and the lesions in the lung?

Clinical summary Discussion

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