Maria Lucia Ribeiro Caldas

Kidney ultrastructural lesions in dogs experimentally infected with Dirofilaria immitis (Leidy, 1856)

Kidneys of 16 beagles with experimentally induced heartworm (Dirofilaria immitis) infections and 4 heartworm-nai;ve dogs were studied by light and electron microscopy. The infections were induced either by subcutaneous injection of infective larvae or by the transplantation of adult parasites, and infection periods varied from 111 to 818 days and 365 to 923 days, respectively. One control group of heartworm-naïve dogs and four groups of heartworm-infected dogs, which were divided according to the type and the length of infection, were used. In the infected dogs, thickening of the glomerular basement membrane (GBM), the presence of dense deposits in the GBM, and foot process effacement were the most frequent lesions observed. In some dogs, electron dense deposits were seen in the GBM and the mesangium and/or enlargement of the mesangial matrix could be characterized. The longer the infection period, the thicker the GBM and the more common the occurrence of foot process effacement. In general, these alterations were more evident in animals that had been infected for more than 1 year, had high microfilaremia, and had 14 or more parasites in the main pulmonary artery and its branches. The presence of dense deposits suggests that the pathogenesis of kidney disease in dirofilariasis is associated with deposits of immune complexes in the membrane. The finding of ultrastructural changes in dogs with early prepatent infections suggests that immature heartworms, as well as microfilariae and possibly adult worms, contribute to the glomerulonephropathy.

Patologia do transplante renal: achados morfológicos principais e como laudar as biópsias

Renal transplant has reached remarkable and growing rates of success since its introduction; nowadays it is a widely used replacement therapy. Renal allograft biopsies are increasingly more frequent in the routine of pathology laboratories, whose histological findings are varied. This paper results from the expertise of the members of the Kidney Club of Sociedade Brasileira de Patologia, and presents a general overview of renal allograft pathology, focusing on the current Banff classification, its main categories and cases of difficult diagnosis.

Early Gestational Hemolytic Uremic Syndrome: Case Report and Review of Literature

Hemolytic uremic syndrome (HUS) is a rare condition which most frequently follows gastrointestinal or respiratory infection episodes in young children, but it can also occur in other settings such as the postpartum period and during use of drugs such as oral contraconceptives, immunosuppressors, and antineoplastics. In early pregnancy, however, its frequency is thought to be very low. The authors report a case of a 30-year-old woman who developed HUS early in her first pregnancy. She had persistent aqueous diarrhea from the beginning of the pregnancy. At the 21st week she developed hypertension which in 2 weeks was followed by seizures, oliguria, and acute pulmonary edema despite intensive medical efforts to control her blood pressure. Surgical intervention for fetal delivery was performed. The patient was initially kept on continuous hemodialysis (CVVHD) followed by an alternate-day conventional hemodialysis schedule. A peripheral blood analysis showed a microangiopathic hemolytic anemia with thrombocytopenia; blood coagulation tests were completely normal. A brain CT scan and an abdominal MRI showed no major abnormalities. HUS was confirmed by a percutaneal kidney biopsy, performed at the 21st day of anuria. Techniques for identification of verotoxin-producing E. coli were not available. Renal function did not recover and the patient has been undergoing regular maintenance hemodialysis for a year.

Nefropatia induzida por contraste: avaliação da proteção pela n-acetilcisteína e alopurinol em ratos uninefrectomizados

OBJECTIVE: Contrast medium-induced nephropathy is the third most frequent cause of iatrogenic acute renal failure involving inpatients. The present study was aimed at evaluating the protective effect of n-acetylcysteine and allopurinol in both male and female rats receiving diatrizoate. MATERIALS AND METHODS: Thirty-five young adult Wistar rats submitted to hydric restriction were divided into groups as follows: groups 1 and 2 (respectively male and female rats) receiving saline solution; groups 3 and 4 (respectively male and female rats) receiving diatrizoate; group 5 (male rats) receiving diatrizoate and n-acetylcysteine; group 6 (male rats) receiving diatrizoate and allopurinol; and group 7 (male rats) receiving diatrizoate and n-acetylcysteine + allopurinol. The glomerular filtration was evaluated by measurement of creatinine clearance. Students t-test and the test of signal were utilized for statistical analysis. RESULTS: Animal models receiving allopurinol did not present a significant increase in the creatinine levels, while n-acetylcysteine did not prevent the creatinine levels increase. CONCLUSION: Allopurinol has shown to be more effective than n-acetylcysteine in the renal function protection against sodium diatrizoate-induced damages. No difference has been found between male and female groups as regards the intensity of sodium diatrizoate-induced renal damages.

Neuropatia múltipla por arterite de células gigantes: registro clínico-patológico de um caso

The case of a 67 years old woman with giant cell arteritis and neuritis multiplex is reported. The diagnosis was based on the microscopic appearances of temporal artery biopsy specimens. The authors described the involvement of peripheral nerves in this disease and made differential diagnosis with polyarteritis nodosa. There was also hemorragic infarction of the brain without giant-cells in brain vessels. It is concluded that this diagnosis should be considered in any elderly patient with peripheral neuropathy.

Reduced Flow after Tubularized Incised Plate Urethroplasty—Increased Fibrogenesis, Elastin Fiber Loss or Neither?

PURPOSE Low urinary flow rates are common after tubularized incised plate urethroplasty but the etiology remains unclear and may be related to low urethral compliance due to abnormal collagen concentrations and/or fewer elastic fibers in the healed urethral plate. We hypothesized that inserting a preputial mucosal graft over the dorsal raw area after the midline incision may avoid scarring and improve urethral compliance. MATERIALS AND METHODS Adult rabbits were submitted to tubularized incised plate urethroplasty with or without inlay preputial graft according to a previously described protocol. Tissular concentrations of collagens I, III, IV, VI, VIII and XIII were measured. Histomorphometric analysis was used to quantify elastic fibers in the urethra. Tubularized incised plate urethroplasty with and without inlay preputial graft was compared to normal rabbit urethras (controls). RESULTS mRNA concentrations for collagens I, II and XIII were similar between controls and operated rabbits. The proportions between collagens I and III were 1.05, 0.87 and 1.21, respectively, in controls and animals undergoing tubularized incised plate urethroplasty with and without inlay preputial graft. mRNA concentrations for collagen IV and collagens VI/VIII tended to be higher and lower, respectively, in the operated urethras, despite showing statistical significance only for collagen VIII in animals undergoing tubularized incised plate urethroplasty with inlay preputial graft vs controls (p=0.02). The operated animals did not demonstrate a reduced number of elastic fibers in the urethral tissues compared to controls. CONCLUSIONS Elastic fiber number and distribution were similar between tubularized incised plate urethroplasty cases and controls, suggesting that decreased concentrations of elastic fibers do not explain the reduced urethral compliance after tubularized incised plate urethroplasty. The raw area determined by the dorsal urethral incision regenerated after standard tubularized incised plate urethroplasty, while cicatrization with fibrosis occurred in correspondence to the grafted areas after tubularized incised plate urethroplasty with inlay preputial graft.

Granulomatous orchitis in a pre-pubertal school-aged child: Differential diagnosis dilemmas

A 6-year-old male presented with testicular growth and persistent chronic orchiepididymitis with high inflammatory markers (C reactive protein and erythrocyte sedimentation rate). Biopsies of the testes and epididymides showed bilateral epididymal and testicular granulomata, testicular fibrosis and chronic inflammatory infiltration, and the histological diagnosis was granulomatous orchitis. The symptoms receded with oral corticosteroids. Although rare, granulomatous orchitis is a possible diagnosis in children presenting testicular enlargement. It is important to differentiate it from testicular tumors (if necessary with testicular biopsy) and to investigate its association with systemic vasculitis and infectious diseases.

Epidemiological, clinical and laboratorial profile of renal amyloidosis: a 12-year retrospective study of 37 cases.

Background: Renal amyloidosis is one of the main differential diagnoses in the investigation of nephrotic proteinuria in adults, especially elderly patients. Objectives: The aim of this article is to contribute to international research with epidemiologic data of renal amyloidosis, given the lack of uniformity described in the literature. Patients and Methods: A retrospective study of 37 cases of renal amyloidosis diagnosed by kidney biopsy, between 2000 and 2011, considering epidemiological, clinical and laboratory data. Results: Subjects aged between 32 and 80 years. Of the 37 cases, 21 (56.8%) were diagnosed as non-light chain (non-AL) renal amyloidosis and 16 (43.2%) as light chain amyloidosis (AL). There was seen an increase in number of both AL and non-AL cases, with a slight predominance in non-AL. The mean 24-hour proteinuria was 5839.0 mg/day. Hematuria was present in 75% of patients. Hypertension was reported in 34% of patients. Acute renal failure, occurred in about 10% of patients, and chronic loss of renal function was present in about 5% at diagnosis. Conclusions: Renal amyloidosis is a disease of increasing incidence. The forms of clinical presentation proved to be variable, but the presence of proteinuria or nephrotic syndrome in elderly patients should always prompt the suspicion of renal amyloidosis and is a formal indication of renal biopsy.

Validação de construção de tissue microarray para estudo da displasia intraepitelial tubular renal

INTRODUCTION AND OBJECTIVE: Renal cell carcinoma is one of the most malignant urological diseases, corresponding to 1%-3% of solid tumors in adults. The finding of intratubular epithelial dysplasia (IED) next to tumor areas suggests that this can be the biological precursor of some types of renal cell carcinoma (RCC). The objective of this study is to evaluate the use of tissue microarray (TMA) to study IED and RCC by immunohistochemistry (IHC) with Ki-67 and p53 protein to confirm the evidence that IED is the biological precursor of RCC. MATERIAL AND METHOD: This study was performed in archival material from ten nephrectomy surgical specimens from Instituto Nacional de Câncer, between 2000 and 2005. DISCUSSION: TMA technique allows to sample and study several different areas from many patients in the same slide, using just one slide for each IHC marker. Once there was no previous study on IED by TMA, a validation test was needed first. RESULTS: There was no statistical difference between 2 or 4 tissue cores and the whole section analysis. CONCLUSION: TMA validation assay demonstrated that the use of two tissue cores with 1 mm2 each was suitable to evaluate RCC and IED.