LUPUS NEPHRITIS COMPLICATED WITH MALIGNANT HYPERTENSION:FROM RENAL VASCULAR PATHOLOGY TO CLINICAL RELEVANCE

Objective To investigate the clinical and pathological characteristics of lupus nephritis patients complicated with malignant hypertension.Methods We retrospectively studied 19 patients with lupus nephritis complicated with malignant hypertension who underwent renal biopsy between January 2002 and December 2006.Results Of 19 patients,3 were men and 16 were women,with a mean age of 24.4±7.7 years old.All had positive antinuclear antibodies and low serum complement was found in 13 patients.All were anemic and 12 of them were thrombocytopenic.Impaired renal function was found in 17 patients with an average serum creatinine of 184.5±88.9 μmol/L.Severe intrarenal arteriolar lesion was found in all patients.Six patients had lupus vasculopathy,11 patients had renal thrombotic microangiopathy lesion,2 had severe arteriosclerosis.All patients received steroids and immunosuppressive drugs,15 received angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)with resultant well-controlled blood pressure.Thrombocytopenia and hemolytic anemia resolved remarkably.The renal function improved or recovered in 14 of 17 patients,and 3 developed end-stage renal disease on maintenance dialysis.Conclusions Severe intrarenal vascular lesion complicated with renal nephritis parallels clinical manifestation of malignant hypertension.Renal pathology is the key of treatment strategy emphasizing on the significance of renal vascular involvement and type.On the basis of immunosuppressive drugs and steroids to control systemic lupus activity,timely initiation of ACEI/ARB could be of benefit to blood pressure control and long term renal survival.

Potential of Renal Pathology on Refining Syndrome Typing of Chinese Medicine in IgA Nephropathy

Objective： To investigate the potential of renal pathological index as a differential diagnosis factor for Chinese medicine （CM） syndromes typing in IgA nephropathy （IgAN）. Methods： A total of 1,016 patients with IgAN was recruited from November 2001 to November 2004. All the signs and symptoms including picture of the tongue and pulse tracings were collected. All patients were typed according to the CM syndrome typing scheme for chronic primary glomerulopathy. The severity of glomerulus and tubulointerstitial lesions （mild, moderate- severe） were evaluated using lee＇s grading system and the Katafuchi score system. Results： The syndrome types transform in turn by deficiency of both the Spleen （Pi） and Lung （Fei） qi, deficiency of both qi and yin, deficiency of Liver （Gan） and Kidney （Shen） yin and deficiency of Spleen-Kidney （Shen） yang, with the aggravation of pathogenetic condition and that the manifestation of deficiency of qi clinically showed proliferative lesion of glomerular mesangium, while the glomerular sclerosis pathologically showed the manifestation of yin deficiency. Conclusion： Renal pathological findings may be a candidate of objective factors to refine CM syndrome typing process.

Renal Pathology Images Segmentation Based on Improved Cuckoo Search with Diffusion Mechanism and Adaptive Beta-Hill Climbing

Lupus Nephritis(LN)is a significant risk factor for morbidity and mortality in systemic lupus erythematosus,and nephropathology is still the gold standard for diagnosing LN.To assist pathologists in evaluating histopathological images of LN,a 2D Rényi entropy multi-threshold image segmentation method is proposed in this research to apply to LN images.This method is based on an improved Cuckoo Search(CS)algorithm that introduces a Diffusion Mechanism(DM)and an Adaptiveβ-Hill Climbing(AβHC)strategy called the DMCS algorithm.The DMCS algorithm is tested on 30 benchmark functions of the IEEE CEC2017 dataset.In addition,the DMCS-based multi-threshold image segmentation method is also used to segment renal pathological images.Experimental results show that adding these two strategies improves the DMCS algorithm's ability to find the optimal solution.According to the three image quality evaluation metrics:PSNR,FSIM,and SSIM,the proposed image segmentation method performs well in image segmentation experiments.Our research shows that the DMCS algorithm is a helpful image segmentation method for renal pathological images.

Clinicopathological Features of Renal Amyloidosis: A Single-center Study on 47 Cases

The correlations between the clinicopathological features and the long-term outcomes of renal amyloidosis（RA） were analyzed with a view to develop strategies for improving diagnosis and prognosis of RA. We retrospectively reviewed the clinicopathological characteristics of 47 patients diagnosed with RA between 2004 and 2014 at the Wuhan Union Hospital. The data on the renal histology, clinical manifestations, and prognosis of RA patients were retrieved from the hospital records and characteristic patterns were identified. The histological changes in the kidneys were correlated with the clinical manifestations of RA. Additionally, most RA patients in this study had decreased serum levels of κ light chain and increased urine levels of κ and λ light chains as well as presence of M-protein in the urine and serum. Patients with early RA showed no specific pathognomonic symptoms. Bleeding associated with diagnostic renal biopsy was rare. We recommend that the routine work-up of patients aged over 40 years and presenting with non-diabetic nephropathy includes the non-invasive tests for the measurement of serum and urine levels of κ and λ light chains as well as protein electrophoresis tests for the presence of urinary and serum M-protein. Additionally, such patients should undergo renal biopsy screening with Cong-red staining to ensure early diagnosis of RA and improve their survival, since the risk of hemorrhage related to renal biopsy screening is low at early stages of RA.

Effects of Sub-chronic Aluminum Exposure on Renal Pathologic Structure in Rats

A total of 40 Wistar rats, weighing 130-140 g, were allocated randomly into four groups. They were orally administrated with 0 （control group, GC）, 64.18 （low-dose group, GL）, 128.36 （middle-dose group, GM）, and 256.72 （high-dose group, GH） mg aluminum chloride （AlCl3） per kilogram body weight in drinking water for 120 days. Kidney coefficient and aluminum （Al） concentrations in blood and kidney were determined, and renal autopsy and histological changes were observed. The results showed that kidney coefficient in all Al-treated groups were obviously lower than that in GC （P〈0.01） and there was a dose-effect relationship. The kidneys were solid, lusterless and pale brown with white necrosis point on surface. Under electron microscope, renal cortex became thin, the renal tubule was narrowed and the epithelium dissolved; the renal glomerulus became atrophied and the glomerular became vasodilator. The Al concentrations in blood and kidney were higher in all Al-treated rats than those in GC （P〈0.01）, and there was a dose-effect relationship. The results indicated that sub-chronic Al exposure could lead to Al accumulation in kidney, restrain the development of kidney and cause the pathologic damage in rats.

SONOGRAPHIC PATTERNS AND DIFFERENTIAL DIAGNOSIS OF CYSTIC RENAL CARCINOMAS

OBJECTIVE: To study the sonographic features and patterns of cystic renal carcinomas. METHODS: Thirteen cases of cystic renal carcinoma confirmed by operation and pathology were examined by ultrasonography, and the cystic walls, septa and solid mural nodules were studied. RESULTS: Solid mural nodules of some cases and irregular thickening of the cystic walls and septa were characteristic findings for the ultrasonic diagnosis of cystic renal carcinomas. According to their pathologic mechanisms and sonographic features, cystic renal carcinomas were classified into 3 patterns: unilocular cystic mass, multiloculated cystic mass and cystic-solid mass. CONCLUSIONS: Typical cystic renal carcinomas can be well diagnosed, while atypical cases may be misdiagnosed as benign renal cysts by ultrasonography. Color Doppler ultrasonography and needle aspiration guided by ultrasonography are helpful in the diagnosis of these atypical cases.

Pathological clavicular fracture as first presentation of renal cell carcinoma: a case report and literature review

Renal cell carcinoma(RCC) accounts for approximately 3% of all cancer cases. RCCs usually metastasize to the lungs, bones, liver, or brain. Only <1% of patients with bone metastases manifested clavicular RCC metastases. Thus, clavicular metastasis as the initial presentation of RCC is extremely rare. We report a patient with RCC metastasis to the left clavicle, which was first presented with pain caused by a pathological fracture. Magnetic resonance image revealed a renal tumor, and technetium-99m–methylene diphosphonate bone scintigraphy showed multiple osseous metastases. The patient eventually underwent surgery to remove the lateral end of the left clavicle and right kidney. Histopathology revealed renal tumor and clear cell carcinoma in the clavicle. Finally, we review 17 cases of clavicular metastases originating from different malignancies.

Expression of DLK1 protein and its correlation with renal cell carcinoma pathological characteristics

Objective To identify the expression of DLK1 protein in different types of renal cell carcinomas and its correlations with pathological characteristics and metastasis. Methods Immunohistochemistry analysis was performed to evaluate the expression of DLK1 protein in

Pathologic analysis of donor grafts in 482 cases of renal transplantation recipients

Objective To evaluate the correlation between the pathologic findings of donor renal grafts and the post-transplantative diseases throuth the biopsies of donor grafts in 482 cases. Methods The renal structures of biopsies of the donor grafts in 482 cases were observed under microscope, and the pathologic findings combined with the post-transplantative conditions were analysed. Results After transplantation, acute rejection occurred in 71 cases,of when 16(22.5%) had adverse changes in donor grafts; chronic allograft nephropahty developed in 17 cases, of whom 7 (41.2% ) had adverse changes in donor grafts; elevated sera creatinine levels with unknown causes occurred in 39 cases, of whon 7(18.0% ) had adverse changes in donor grafts. The lesion of donor renal grafts had nothing to do with the acute rejection or other abnormalities after operation ( r≤ 0.3) but some kind of lesion had certain correlation with chronic allograft nephropathy(CAN, r 】0.3). Conclusion Routine biopsy of donor renal graft is

Epidemiological, Diagnostic, Therapeutic and Progressive Aspects of Arterial Hypertension in Children at the University Hospital Center of Bouaké (Côte d’Ivoire)

Introduction: Arterial hypertension (AH) in children is under-diagnosed and often has a poor prognosis. The aim of this study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of hypertension in children at the University Hospital of Bouaké, with a view to improving the prognosis. Methods: This was a cross-sectional, analytical study carried out in the paediatrics department of Bouaké University Hospital. It concerned the medical records of children aged 4 to 15 hospitalised from 1 January 2017 to 31 December 2020 for hypertension. Diagnosis was based on the simplified blood pressure guidelines of the Expert Consensus of the French Society of Hypertension. The variables studied were epidemiological, diagnostic, therapeutic and evolutionary. Quantitative variables were compared at the significance level p ≤ 0.05. Results: The hospital incidence of hypertension was 0.32% (69/21,642). The sex ratio was 0.72. 97.1% of the children were over five years of age. Oedema (49.3%) and breathing difficulties (20.2%) were the main reasons for consultation. Hypertension was classified as threatening (56.5%), confirmed (31.9%) and borderline (11.6%). The cause was renal in 66.7%, dominated by impure nephrotic syndrome (24.6%). Treatment for hypertension consisted mainly of a diuretic (79.7%) and a calcium channel blocker (47.8%). Outcome was favourable in 50.7% of cases. Mortality was 20.3%. No factor was significantly associated with death. Conclusion: Hypertension in children at Bouaké University Hospital is serious. The aetiology is mainly renal. Early diagnosis and management are key to improving prognosis.

COVID-19 induced renal injury differs from that in other viral-infections

Background:Kidney injuries caused by several viral diseases have been reported worldwide among all age groups,races,and genders.Of particular importance is coronavirus disease 2019(COVID-19),and its prevalence in communities infecting all patient populations with symptoms ranging from asymptomatic to severe,including complications and mortality.Methods:Data were acquired from PubMed,Scopus,Google Scholar,Centers for Disease Prevention and Control(CDC),and Lexi-Comp using the following search terms:“COVID-19 and renal pathology,”“COVID-19 induced kidney disease,”“Viral infection induced kidney disease,”and“Viral infection induced renal damage.”Titles and abstracts were manually analyzed as per the exclusion and inclusion criteria of relevant articles;relevance of articles included studies on the pathology of a specific viral infection and the impact of the virus on the adult renal system.Results:The mechanisms for renal disease due to COVID-19 include direct renal tubular injury,cytokine storm,inflammation,thrombosis vs.acute tubular necrosis,thrombotic events,and direct renal injury.Although some mechanisms behind renal dysfunction among the studied viral infections are similar,the prevalence rates of kidney injury or damage differ.This might be described by recommended prophylactic and therapeutic approaches that can alter the viral infection characteristics and possibly the impact a particular organ system.Conclusion:The patient population at risk was old in age and had a high body mass index.The mechanisms associated with renal dysfunction are similar,including direct renal injury through angiotensin converting enzyme 2(ACE2)entry,inflammation,and thrombosis.The renal pathology of coronaviruses that differs from that of other prevalent viral infections is the activation of cytokine storm,which causes elevations of a greater number and different kinds of cytokines than other viral infections.

Study on the Relationship between Blood Stasis Syndrome and Clinical Pathology in 227 Patients with Primary Glomerular Disease

To investigate the relationship between the severity of Chinese medicine(CM) bloodstasis syndrome(BSS) with clinical features and renal lesion indexes of the primary glomerular disease. Methods:An epidemiological survey was conducted to collect the data of 227 patients diagnosed as chronic primary glomerular diseases,and their severity of BSS were scored three days before renal biopsies were performed.The following clinical indexes were analyzed:age,course of glomerular diseases,24-h urine protein ration(Up...

Pathological demography of native patients in a nephrology center in China

Objective To analysis the pathological demography in Chinese patients undergoing renal biopsy from our niphrology center.Methods Between January 1979 and October 2000 in Jinling Hospital, Nanjing, China, 10 002 attempts of percutaneous renal were performed in patients with renal disease from 33 provinces of China. The pathological classifications were made according to the WHO criteria of 1982 for renal pathology or the modified WHO criteria of 1995 by a panel of pathologists and nephrologists during routine clinical-pathological rounds. The pathological demography between those specimens collected from 1979 -1989 and those from 1990 -1999 was compared.Results The mean age of the 10002 subjects undergoing renal biopsy was 31.4 ?3.0 years (ranging from 1 to 78 years), with a male to female ratio of 1. 3: 1; for the 592 renal transplant recipients, the mean age was 37. 5 ±9. 1 years (ranging from 16 to 66 years), with a male to female ratio of 2.36: 1. Primary glomerular diseases (PGD) accounted for 71% of the total patients undergoing renal biopsies, secondary glomerular nephritis (SGN) 23%, tubular-interstitial diseases 3. 2% , unclassified renal diseases 1. 3% , hereditary and congenital renal diseases 1. 0% , end stage renal diseases 0. 96% , and recently realized or rare renal diseases 0. 15%. IgA nephropathy (IgAN) was the most frequent pathological pattern (40%) of PGD, followed by mesangial proliferative lesion (MsPL) (30%), membranous nephropathy (MN) (10%), and focal segmental glomerulosclerosis ( FSGS) (6%). Lupus nephritis (LN) was the most pathology common seen (74%) in SGN. During the 22 years of the study period, there was a steady increase in patients with SGN discovered during pathological evaluation of renal disorders. A rise in prevalence was found in IgA nephropathy, MN (both P<0.001), crescentic glomerulonephritis (P<0. 0001), anti-GBM disease, and hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura related renal damages ( both P < 0. 001 ). There was a decrease in endocapillary proliferative glomerulonephritis ( P < 0. 001 ) and IgM nephropathy (IgMN) ( P < 0. 01) from 1990 - 1999 as compared to 1979 - 1989. Infrequent renal pathological entities were also diagnosed in this group, including Niemann Pick disease, Fabry' s disease, POEMS syndrome, and lipoprotein glomerulonephropathy.Conclusions This is the largest series of renal biopsy data in China, and therefore may reflect the demographic picture of renal diseases in this country. Changes in prevalence of renal pathological entities were reflected in this group of patients over the last 22 years. In primary glomerular diseases, IgA nephropathy is still the most frequently observed pathological pattern. In SGN, LN appeared the most often. Increased prevalence was found in anti-GBM nephritis and HUS/TTP.