Efferent Arteriolar Hyalinosis

A 63-year old woman affected by splenomegaly, anemia and moderate leukocytosis was submitted to splenectomy for a supposed Banti disease. Histological examinations showed splenic invasion by undifferentiated mesenchymal cells with partial myeloid differentiation and with arteriolar hyalinosis; hepatic biopsy revealed only a moderate phlogosis. Following splenectomy a rapid enlargement of the liver was observed, with increase of erythrocytes to 5.6 millions per mm3 and appearance of erythroblasts in the circulating blood; neutrophilic leukocytosis to 200,000 cells per mm3 with presence of myelocytes and metamyelocytes and of occasional atypical cells; increase of platelets to 500,000 elements per mm3 with giant thrombocytes; bone marrow showed areas of fibrosis and a normal formula. The patient died 27 months after splenectomy with a terminal period of profuse enterorrhagia and anemia; post-mortem examination of the liver showed infiltration of cells of erythroblastic type and diffuse cirrhotic fibrosis. The case has been ascribed to the myelofibrosis and defined as a « panmyelosis with fibrotic evolution », with prevailing spleno-hepatic involvement, erythro-leuko-thrombocytemia and terminal liver cirrhosis.

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Characteristic Renal Histology of a 81-Year-Old Patient with a 30-Year History of Diabetes Mellitus: A Case Report

CEN Case Reports ◽

10.1007/s13730-020-00483-9 ◽

2020 ◽

Vol 9 (4) ◽

pp. 338-343

Author(s):

Natsuki Shima ◽

Naoki Sawa ◽

Masayuki Yamanouchi ◽

Hiroki Mizuno ◽

Masahiro Kawada ◽

...

Keyword(s):

Diabetes Mellitus ◽

Immunofluorescence Microscopy ◽

Antihypertensive Agents ◽

Diabetic Glomerulopathy ◽

Normal Range ◽

Salt Diet ◽

Protein Excretion ◽

Renal Histology ◽

History Of ◽

Arteriolar Hyalinosis

Abstract A renal histology of an 81-year-old man with a 30-year history of diabetes mellitus (DM), as well as diabetic retinopathy and neuropathy, was examined. The patient’s blood pressure was controlled within the normal range (less than 140/75 mmHg) using antihypertensive agents including angiotensin receptor blocker. Edematous management was achieved by a strict salt diet (less than 6 g/per day). However, this patient’s glycemic control was poor with HbA1c 8–10%. Serum creatinine was 0.87 mg/dL and estimated globular filtration rate (eGFR) was 64 ml/min/1.73m2. Urinary protein excretion was 1.5 g/day. This patient’s renal biopsy showed linear staining for IgG along the GBM by immunofluorescence microscopy, but light microscopy showed almost intact glomeruli, and the GBM was not thickened as revealed by electron microscopy with a width of 288–368 nm (< 430 nm). While arteriolar hyalinosis was severe, and polar vasculosis was observed around the glomerular vascular pole. This case indicates that long-standing hyperglycemia may induce polar vasculosis by the mechanism of angiogenesis, but diabetic glomerulopathy can become minor change, only when hypertension and edematous management could be controlled strictly.

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Renal arteriolar hyalinosis, not intimal thickening in large arteries, is associated with cardiovascular events in people with biopsy‐proven diabetic nephropathy

Diabetic Medicine ◽

10.1111/dme.14301 ◽

2020 ◽

Vol 37 (12) ◽

pp. 2143-2152 ◽

Cited By ~ 1

Author(s):

K. Morimoto ◽

M. Matsui ◽

K. Samejima ◽

T. Kanki ◽

M. Nishimoto ◽

...

Keyword(s):

Diabetic Nephropathy ◽

Cardiovascular Events ◽

Intimal Thickening ◽

Large Arteries ◽

Arteriolar Hyalinosis

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Kidney Structural Features from Living Donors Predict Graft Failure in the Recipient

Journal of the American Society of Nephrology ◽

10.1681/asn.2019090964 ◽

2020 ◽

Vol 31 (2) ◽

pp. 415-423 ◽

Cited By ~ 3

Author(s):

Naim Issa ◽

Camden L. Lopez ◽

Aleksandar Denic ◽

Sandra J. Taler ◽

Joseph J. Larson ◽

...

Keyword(s):

Graft Failure ◽

Clinical Characteristics ◽

Interstitial Fibrosis ◽

Kidney Transplant Recipient ◽

Structural Features ◽

Living Donors ◽

Nephron Number ◽

Tubular Atrophy ◽

Cross Sectional ◽

Arteriolar Hyalinosis

BackgroundNephrosclerosis, nephron size, and nephron number vary among kidneys transplanted from living donors. However, whether these structural features predict kidney transplant recipient outcomes is unclear.MethodsOur study used computed tomography (CT) and implantation biopsy to investigate donated kidney features as predictors of death-censored graft failure at three transplant centers participating in the Aging Kidney Anatomy study. We used global glomerulosclerosis, interstitial fibrosis/tubular atrophy, artery luminal stenosis, and arteriolar hyalinosis to measure nephrosclerosis; mean glomerular volume, cortex volume per glomerulus, and mean cross-sectional tubular area to measure nephron size; and calculations from CT cortical volume and glomerular density on biopsy to assess nephron number. We also determined the death-censored risk of graft failure with each structural feature after adjusting for the predictive clinical characteristics of donor and recipient.ResultsThe analysis involved 2293 donor-recipient pairs. Mean recipient follow-up was 6.3 years, during which 287 death-censored graft failures and 424 deaths occurred. Factors that predicted death-censored graft failure independent of both donor and recipient clinical characteristics included interstitial fibrosis/tubular atrophy, larger cortical nephron size (but not nephron number), and smaller medullary volume. In a subset with 12 biopsy section slides, arteriolar hyalinosis also predicted death-censored graft failure.ConclusionsSubclinical nephrosclerosis, larger cortical nephron size, and smaller medullary volume in healthy donors modestly predict death-censored graft failure in the recipient, independent of donor or recipient clinical characteristics. These findings provide insights into a graft’s “intrinsic quality” at the time of donation, and further support the use of intraoperative biopsies to identify kidney grafts that are at higher risk for failure.

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MO646PATHOLOGICAL PROGNOSTIC FACTORS IN DIABETIC NEPHROPATHY: A RETROSPECTIVE STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab094.0014 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Aurélie Sannier ◽

Valentin Maisons ◽

Mickael Bobot ◽

Francois Vrtovsnik ◽

Noemie Jourde-Chiche ◽

...

Keyword(s):

Diabetic Nephropathy ◽

Prognostic Value ◽

Patient Survival ◽

Kidney Diseases ◽

Biological Data ◽

Renal Pathology ◽

Renal Survival ◽

Nodular Glomerulosclerosis ◽

Arteriolar Hyalinosis

Abstract Background and Aims Kidney Biopsies (KB) performed in patients with Type-2 diabetes (T2D) usually aim at differentiating diabetic nephropathy (DN) from other kidney diseases. However, KB could also help refining patients’ prognosis, both in terms of renal survival, and in terms of patient survival. In 2010, the Renal Pathology Society developed a pathological classification of DN, but the prognostic value of the described items , is still imperfectly documented. We aimed to assess the prognostic performances of these items to predict renal and patient survival. Method Native KBs with diabetic and/or hypertensive nephropathy (DN/HN) performed in patients with T2D in four French centers were analyzed and scored according to the classification developed by the Renal Pathology Society. Clinical and biological data was collected from the patients’ records. Survival analyses were performed for renal survival (time to first dialysis or preemptive transplantation) and death after dichotomization of continuous data). For each of the analyses, we first established a model comprising clinical data only. We then assessed the benefit of adding each of the pathological item to the clinical model. Finally, we performed a backward stepwise analysis to identify items predictive of renal and/or patient survival. Results We analyzed 165 biopsies with DN/HN from patients with T2D and with at least 12 months of follow-up (unless they reached an endpoint during the first year). Among them, 73 (44%) were male, 155 (94%) had hypertension, 53 (34%) hematuria, 22 (15%) had proliferative diabetic retinopathy (DR), 33 (23%) had non-proliferative DR, 90 (62%) had no DR (20 had missing data). Mean (SD) age was 63 (11), median [IQR] eGFRCKD-EPI was 29 [18;45] ml/min/1.73m², urinary protein-to-creatinine ratio was 0.38 [0.14;0.83] g/mmol, HbA1c was 7 [6.2;8.2] % and diabetes duration before KB was 10 [5;19] years. The median [IQR] follow-up was 33 months[18;57]. During the follow-up, 43 (26%) patients died and 69 (42%) required renal replacement therapy (RRT). The percentage of ischemic glomeruli, and presence of more than one area of arteriolar hyalinosis (ah=2), were predictive of renal survival and improved the predictive value of the model when added to clinical parameters. Presence of at least one convincing Kimmelstiel–Wilson lesion (nodular glomerulosclerosis or Class III DN) was predictive of death and similarly improved the predictive model (See figure). Conclusion Pathological findings on KB, as classified by the Renal Pathology Society, carry significant prognostic value in patients with T2D and DN/HN. Vascular lesions (presence of arteriolar hyalinosis and less than 7% of ischemic glomeruli) predicted the need for RRT, while nodular glomerulosclerosis was predictive of death.

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Neuropathology of Spontaneous Hypertensive Encephalopathy in Cats

Veterinary Pathology ◽

10.1177/0300985819849500 ◽

2019 ◽

Vol 56 (5) ◽

pp. 778-782 ◽

Cited By ~ 3

Author(s):

Molly E. Church ◽

Bradley J. Turek ◽

Amy C. Durham

Keyword(s):

White Matter ◽

Acute Onset ◽

Hypertensive Encephalopathy ◽

Left Ventricular ◽

Vascular Lesions ◽

Systemic Hypertension ◽

Cerebral White Matter ◽

Pathologic Features ◽

Gross Lesions ◽

Arteriolar Hyalinosis

Pathologic features of 12 cats with naturally acquired systemic hypertension and concomitant hypertensive encephalopathy were analyzed. All cats demonstrated acute onset of signs localized to the forebrain and/or brainstem, including stupor, coma, and seizures. All cats had systemic hypertension, ranging from 160 to 300 mm Hg. Gross lesions were identified in 4 of 12 cases, including caudal herniation of the cerebrum and cerebellum, sometimes with compression of the rostral colliculus and medulla. Histologically, all cases featured bilaterally symmetrical edema of the cerebral white matter. Associated vascular lesions, especially arteriolar hyalinosis, were also observed. Concurrent lesions were chronic tubulointerstitial nephritis (11/12 cases), adenomatous hyperplasia of the thyroid gland (4 cases), hypertensive choroidal arteriopathy (6 cases), and left ventricular hypertrophy (5 cases). This study demonstrates that the typical histologic manifestation of spontaneous hypertensive encephalopathy in cats is bilaterally symmetrical edema of the subcortical cerebral white matter.

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Synergistic Impact of Diabetes and Hypertension on the Progression and Distribution of Glomerular Histopathological Lesions

American Journal of Hypertension ◽

10.1093/ajh/hpz059 ◽

2019 ◽

Vol 32 (9) ◽

pp. 900-908 ◽

Cited By ~ 2

Author(s):

Takaya Sasaki ◽

Nobuo Tsuboi ◽

Yusuke Okabayashi ◽

Kotaro Haruhara ◽

Go Kanzaki ◽

...

Keyword(s):

Renal Cortex ◽

Glomerular Hypertrophy ◽

Zonal Distribution ◽

Histopathological Lesions ◽

Arterial Lesions ◽

Glomerular Lesions ◽

Medical Histories ◽

Global Glomerulosclerosis ◽

Arteriolar Hyalinosis ◽

Different Parts

Abstract BACKGROUND Diabetes and hypertension share renal histopathological features, such as arterial lesions and glomerular hypertrophy, that have not been investigated in relation to the blood pressure status of diabetic subjects. The severity of glomerular lesions varies across locations of the renal cortex, which may be further affected by diabetes and/or hypertension. METHODS Histopathological lesions in different parts of the renal cortex of autopsy kidneys were evaluated and analyzed based on medical histories of diabetes and hypertension. RESULTS This study included a total of 82 Japanese autopsies composed of normotensive nondiabetics (n = 31), hypertensive nondiabetics (n = 28), normotensive diabetics (n = 14), and hypertensive diabetics (n = 9). There were no differences in age, sex, renal function, or body size among groups. In both the superficial and juxtamedullary cortices, increased glomerular volume (GV) was significantly associated with either diabetes or hypertension. In addition, diabetes and hypertension showed a significant interaction with GV regardless of the cortical location. Values for global glomerulosclerosis (GGS) and arteriolar hyalinosis (AH) were associated with diabetes but not with hypertension. Only values for GGS consistently showed cortical surface superiority. The zonal distribution of AH, GV, or other diabetic glomerular lesions differed among the lesions depending on the presence or absence of hypertension. CONCLUSIONS These results imply that diabetes and hypertension synergistically enhance glomerular hypertrophy across all layers of the human renal cortex. The process is closely associated with the severity of GGS and AH predominantly associated with diabetes.

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