Case 14.20:
Questions:
1) What is shown on the light microscopy image (hematoxylin and eosin stain) in Figure 1A?
Light microscopy of the kidney biopsy tissue reveals multi-focal necrotizing tubulocentric granulomatous inflammation.
2) What is shown on the image prepared with an immunohistochemical stain in Figure 1B?
Adenovirus stained positively (dark brown color) within tubular cells using the immunohistochemical stain targeting adenovirus.
3) What is the diagnosis?
The diagnosis is adenovirus infection of the transplant kidney, which presented clinically with fever, gross hematuria and mild acute kidney injury. Treatment includes a reduction in immunosuppression. At times, cidofovir is employed when there disseminated infection and/or lack of response to immunosuppression reduction.
See published case https://kidney360.asnjournals.org/content/1/7/712
Case 15.20:
Questions:
1) What is shown on the plain roentgenogram image in Figure 1?
Pain and swelling in the patient is caused by a 7.2 cm x 4 cm expanding lytic lesion with periosteal reaction in the right humerus.
2) What is the diagnosis?
The patient has a “brown tumor” due to longstanding, severe secondary hyperparathyroidism. Brown tumors have often a cyst-like radiolucent appearance on plain roentgenogram. When there are multiple lesions, they can mimic metastatic disease or multiple myeloma. Medical or surgical treatment of secondary hyperparathyroidism is required. Surgical treatment of the brown tumor itself may be required when erosive lesions are associated with severe symptoms such as neurological compromise, cauda equine syndrome, or facial deformities.
See published case https://kidney360.asnjournals.org/content/1/7/714
Case 16.20:
Questions:
1) What is shown on the light microscopy image (hematoxylin and eosin stain) in Figure 1A?
Calcium oxalate crystals are observed within the tubular lumens of the kidney biopsy.
2) What is shown on the polarized image in Figure 1B?
Calcium oxalate crystals within numerous tubular lumens are positively birefringent by polarized light image of the kidney biopsy.
3) What is shown on the electron microscopy image in Figure 1C?
Calcium oxalate crystals within a tubular lumen are observed on the electron microscopy image of the kidney biopsy.
4) What is the diagnosis?
Acute oxalate nephropathy due to excessive oxalate intake associated with ingestion of the drink from vegetable juicing. Oxalate absorbed from the GI tract enters the bloodstream and enters the tubular lumens. The excessive oxalate in the tubular lumens combines with calcium and precipitates. A combination of tubular obstruction and associated inflammatory response leads to acute tubular injury.
See published case https://kidney360.asnjournals.org/content/1/7/716
Case 17.20:
Questions:
1) What is shown on the CT scan image of the lung in Figure 1A?
CT scan of the chest without intravenous contrast demonstrates bilateral posterior upper lobe consolidations (arrows) due to the coronavirus.
2) What is shown in Figure 1B?
Blood clots (arrows) that formed due to the pro-thrombotic state of COVID-19 infection were extracted from the continuous kidney replacement therapy (CKRT) circuit tubing are shown in this image.
3) What is shown on the CT scan image of the brain in Figure 1C?
CT scan of the head without intravenous contrast reveals a left frontal infarct (arrow) that likely represents a thrombotic event related to COVID-19-related pro-thrombotic state.
4) What is the diagnosis?
COVID-19 infection in this patient is complicated by pulmonary infection. A pro-thrombotic state has been described in the setting of COVID-19 infection. Thrombosis of the CKRT filter and lines developed, while the patient also suffered from a CVA due to the pro-thrombotic state associated with the viral infection.
See published case https://kidney360.asnjournals.org/content/1/7/718