Renal biopsy findings in long‐term cyclosporin treatment of psoriasis

We are presenting a case of renal failure with anti-GBM and p-ANCA antibodies positive. Patients with dual antibodies are considered to be a vasculitis-variant of anti-GBM antibody nephritis. These patients may have atypical presentation and it may delay diagnosis and treatment. Recurrence rate is higher in these patients. We reviewed the literature of cases and studies on cresenteric glomerulonephritis with anti-GBM and p-ANCA positive patients. We recommend that patients suspected with pulmonary-renal syndrome should be checked for anti-GBM and p-ANCA antibodies, should undergo renal biopsy and should should have close long term follow up to watch for recurrence.

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A comparative study on renal biopsy before and after long-term calcineurin inhibitors therapy: an insight for pathogenesis of its toxicity

Human Pathology ◽

10.1016/j.humpath.2014.09.003 ◽

2015 ◽

Vol 46 (1) ◽

pp. 34-39 ◽

Cited By ~ 13

Author(s):

Lavleen Singh ◽

Geetika Singh ◽

Alok Sharma ◽

Aditi Sinha ◽

Arvind Bagga ◽

...

Keyword(s):

Comparative Study ◽

Renal Biopsy ◽

Calcineurin Inhibitors ◽

Before And After

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Renal biopsy in very elderly patients (over 80 years): clinical presentation, histological diagnosis, and long-term outcome

International Urology and Nephrology ◽

10.1007/s11255-020-02403-3 ◽

2020 ◽

Vol 52 (4) ◽

pp. 721-729

Author(s):

Martin Planchais ◽

Benoit Brilland ◽

Julien Demiselle ◽

Virginie Besson ◽

Agnès Duveau ◽

...

Keyword(s):

Elderly Patients ◽

Renal Biopsy ◽

Clinical Presentation ◽

Histological Diagnosis ◽

Very Elderly ◽

Term Outcome ◽

Long Term Outcome

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035 Interferon beta induced thrombotic microangiopathy in multiple sclerosis: a clinical-pathological report

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-anzan.34 ◽

2018 ◽

Vol 89 (6) ◽

pp. A15.1-A15 ◽

Cited By ~ 3

Author(s):

Charmaine Yam ◽

Anthony Fok ◽

Catriona McLean ◽

Ernest Butler ◽

Peter Kempster

Keyword(s):

Multiple Sclerosis ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Renal Biopsy ◽

Thrombotic Microangiopathy ◽

Interferon Beta ◽

Pulmonary Arterial ◽

Multiple Sclerosis Patients ◽

Dose Dependent

IntroductionThrombotic microangiopathy (TMA) has been described with long-term interferon-beta (IFN-β). We report a case of biopsy-proven TMA in a patient with multiple sclerosis (MS) who had been having IFN-β−1a injections for twenty years. These biopsy findings were similar to previously described lung histological changes in IFN β- induced pulmonary arterial hypertension (PAH).CaseA 57 year old woman with relapsing-remitting multiple sclerosis had been administering IFN-β−1a injections for twenty years. Her BMI was 21 and she was on a dose of 44 mcg three times per week. She presented with acute pulmonary oedema, renal failure, malignant hypertension, micro-angiopathic haemolytic anaemia and thrombocytopenia after one week of increasing dyspnoea. A renal biopsy showed malignant hypertensive nephropathy and microangiopathy consistent with TMA. Alternative TMA syndromes including haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura were excluded. Renal function stabilised after the IFN was ceased but never returned to the baseline level.ResultsHer renal biopsy showed glomerular capillary thrombus deposition, endothelial reactivity, vessel necrosis and wall duplication with luminal thrombus. Fibromuscular proliferation, focal fibrinoid necrosis and luminal thrombus was also present within arterioles. These microvascular histopathological findings resemble vessel changes observed seen in lung biopsies in human IFN β mediated PAH, and those described in transgenic mouse models engineered to overproduce Type 1 IFN.1 2 Our patient was on treatment for twenty years at a dose exceeding 50 mcg per week. Both are postulated risk factors for the development of TMA.2ConclusionOur report highlights similarities between microvascular changes seen in IFN-induced TMA and those observed in pulmonary arterial hypertension associated with IFN therapy. This suggests a shared pathophysiological mechanism. Kavanagh et al had described a dose-dependent spectrum of renal microvascular disease in his mouse model.2 The duration and high dosage for weight of IFN Β supports a cumulative drug toxicity effect.References. Fok A, Williams T, McLean C, Butler E. Interferon beta- 1a long-term therapy related to pulmonary arterial hypertension in multiple sclerosis patients. Mult Scler2016Oct;22(11):1495–1498.. Kavanagh D, McGlasson S, Jury A, et al. Type I interferon causes thrombotic microangiopathy by a dose-dependent toxic effect on the microvasculature. Blood2016Aug;05–715987.

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Long-term prognosis in lupus nephritis: relation to the renal biopsy data, therapy, and grade of remission

Japanese Journal of Rheumatology ◽

10.3109/bf03041270 ◽

1999 ◽

Vol 9 (2) ◽

pp. 135-145 ◽

Cited By ~ 1

Author(s):

Yoshiaki Tokano ◽

Hirofumi Amano ◽

Syhei Takai ◽

Kenjiro Yamanaka ◽

Masahiro Sugawara ◽

...

Keyword(s):

Lupus Nephritis ◽

Renal Biopsy ◽

Long Term Prognosis

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Immunohistochemistry of deparaffinised sections using antigen retrieval with microwave combined pressure cooking versus immunofluorescence in the assessment of human renal biopsies

Journal of Clinical Pathology ◽

10.1136/jclinpath-2012-201125 ◽

2013 ◽

Vol 66 (5) ◽

pp. 374-380 ◽

Cited By ~ 5

Author(s):

Suozhu Shi ◽

Ping Zhang ◽

Qingli Cheng ◽

Jie Wu ◽

Jing Cui ◽

...

Keyword(s):

Renal Biopsy ◽

Tissue Structure ◽

Antigen Retrieval ◽

Renal Diseases ◽

Positive Staining ◽

Pressure Cooking ◽

Tissue Sections ◽

Simultaneous Evaluation ◽

Long Term Preservation

BackgroundImmunofluorescence of frozen tissue sections (IF-F) is a traditional technique used in renal biopsy. However, IF-F has certain disadvantages, such as a few or even no glomeruli in the section, and limited long-term preservation of the fluorescently labelled samples.MethodsWe compared two-step immunohistochemistry (IHC) staining of deparaffinised sections for antigen retrieval with microwave combined high-pressure cooking to IF-F used to detect antigens of IgG, IgA, IgM, C3, C1q, κ and λ in patient renal biopsy samples. The number of glomeruli detected, sensitivity and specificity of positive staining, tissue structure, and location staining of the antigens were determined using the two methods in 285 patients diagnosed with different renal diseases.ResultsConcordant observations between IF-F and IHC were 99% for all antigen staining (1969 of 1995 observations) and 100% for IgG, IgA and IgM (all 285 observations). The number of glomeruli in IHC sections was significantly greater compared with IF-F sections (p<0.001). IHC provided clearer images of tissue structure, more precise localisation of positive-staining antigens, and IHC staining allowed simultaneous evaluation of tissue by light microscopy. Correlation between tissue structure and immune deposits are not readily attained by IF-F.ConclusionsIHC is superior to IF-F for immunopathological diagnosis of renal biopsy tissue and is a reliable replacement for the more traditional IF-F method.

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