Canadian Association of Pathologists - Case of the Month - November 2007
HIV and Renal Failure
Diagnosis:
HIV-associated nephropathy (collapsing glomerulopathy; focal segmental glomerulosclerosis, collapsing variant).Microscopic Descriptions:
Light microscopy: Some of the glomeruli are globally sclerosed with most of the remaining showing segmental glomerulosclerosis, primarily in the form of collapsed glomerular capillary loops with overlying podocyte hyperplasia. Several foci of segmental glomerular scarring with adhesions are present. The glomeruli show otherwise no increase in mesangial matrix and no increase in cellularity. There is no endocapillary hypercellularity. The glomerular basement membranes appear thickened and wrinkled on PAS stain. There is widespread tubular microcyst formation. There is severe interstitial fibrosis and tubular atrophy affecting approximately 60% of the parenchyma. Diffuse interstitial inflammation is present primarily in scarred parenchyma. There is mild hyaline arteriolosclerosis and moderate arterial sclerosis.
Immunofluorescence microscopy: There is staining for C3 (1+) and IgM (1+). There is no staining for IgG, IgA or fibrin (not shown).
Electron microscopy: Only a small fragment of a glomerulus is examined. The mesangium is unremarkable. There are no immune-type electron-dense deposits. The glomerular basement membranes appear mildly thickened. The visceral epithelial foot processes are diffusely effaced (approximately 80%). High power examination of the glomerulus was not provided, therefore it is not possible to assess for glomerular endothelial tubulo-reticular inclusions.
Further Information:
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Key fields of view |
For more information on HIV nephropathy, see: http://www.emedicine.com/med/topic3203.htm