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The significance of tubuloreticular inclusions as a marker of systemic stimulation by interferons in a case of focal and segmental glomerulosclerosis associated with cytomegalovirus (CMV) infection.

Bromfield M, McQuillan R, John R, Avila-Casado C - Clin Kidney J (2014)

Bottom Line: Patient clinical and laboratory workup revealed the absence of an autoimmune disease but the presence of a subclinical cytomegalovirus (CMV) infection.Therefore, we highlight that the identification of TRIs is a useful indicator of systemic interferon activity.In the present case, the unusual location of numerous TRIs was associated with a subclinical CMV infection in an immunocompetent patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology , Toronto General Hospital, University Health Network, University of Toronto , Toronto ON , Canada.

ABSTRACT
The identification of large numbers of tubuloreticular inclusions (TRIs) in renal biopsies may be useful to raise diagnostic suspicion for certain clinical entities, particularly autoimmune diseases and viral infections. We report a case of a 65-year-old female with a 2-week history of malaise, massive proteinuria and lower extremity edema of acute onset. A renal biopsy was performed and the diagnosis of non-human immunodeficiency virus (HIV) tip-located, early focal segmental glomerulosclerosis (FSGS) was established. The electron microscopy examination was remarkable for the presence of diffuse foot process effacement and frequent TRIs in the endothelial cells of the glomerular capillary loops, endothelium of arterioles and cytoplasm of fibroblasts in the interstitium, highly suggestive of an underlying etiology. Patient clinical and laboratory workup revealed the absence of an autoimmune disease but the presence of a subclinical cytomegalovirus (CMV) infection. Therefore, we highlight that the identification of TRIs is a useful indicator of systemic interferon activity. In the present case, the unusual location of numerous TRIs was associated with a subclinical CMV infection in an immunocompetent patient.

No MeSH data available.


Related in: MedlinePlus

Detail of a glomerulus showing a segmental area of scarring located at the tip with adhesions to the Bowman's capsule. Foam cells are present within the sclerosed capillary loops. The remaining glomerular tuft shows open capillary loops without endocapillary hypercellularity (HE staining and ×200).
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SFT156F1: Detail of a glomerulus showing a segmental area of scarring located at the tip with adhesions to the Bowman's capsule. Foam cells are present within the sclerosed capillary loops. The remaining glomerular tuft shows open capillary loops without endocapillary hypercellularity (HE staining and ×200).

Mentions: Four cores of the renal cortex were examined by a light microscopy. A sample contained 16 glomeruli, none of which were globally sclerosed. Glomeruli were slightly enlarged with prominent podocytes. Areas of early segmental sclerosis located at the tip of the glomeruli were present in two glomeruli, one of which included intraluminal foam cells (Figure 1). The tubulointerstitium was well preserved with mild tubulointerstitial fibrosis and tubular atrophy affecting <20% of the tissue. No arteriolar hyalinosis or arterial sclerosis was identified.Fig. 1.


The significance of tubuloreticular inclusions as a marker of systemic stimulation by interferons in a case of focal and segmental glomerulosclerosis associated with cytomegalovirus (CMV) infection.

Bromfield M, McQuillan R, John R, Avila-Casado C - Clin Kidney J (2014)

Detail of a glomerulus showing a segmental area of scarring located at the tip with adhesions to the Bowman's capsule. Foam cells are present within the sclerosed capillary loops. The remaining glomerular tuft shows open capillary loops without endocapillary hypercellularity (HE staining and ×200).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4377766&req=5

SFT156F1: Detail of a glomerulus showing a segmental area of scarring located at the tip with adhesions to the Bowman's capsule. Foam cells are present within the sclerosed capillary loops. The remaining glomerular tuft shows open capillary loops without endocapillary hypercellularity (HE staining and ×200).
Mentions: Four cores of the renal cortex were examined by a light microscopy. A sample contained 16 glomeruli, none of which were globally sclerosed. Glomeruli were slightly enlarged with prominent podocytes. Areas of early segmental sclerosis located at the tip of the glomeruli were present in two glomeruli, one of which included intraluminal foam cells (Figure 1). The tubulointerstitium was well preserved with mild tubulointerstitial fibrosis and tubular atrophy affecting <20% of the tissue. No arteriolar hyalinosis or arterial sclerosis was identified.Fig. 1.

Bottom Line: Patient clinical and laboratory workup revealed the absence of an autoimmune disease but the presence of a subclinical cytomegalovirus (CMV) infection.Therefore, we highlight that the identification of TRIs is a useful indicator of systemic interferon activity.In the present case, the unusual location of numerous TRIs was associated with a subclinical CMV infection in an immunocompetent patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology , Toronto General Hospital, University Health Network, University of Toronto , Toronto ON , Canada.

ABSTRACT
The identification of large numbers of tubuloreticular inclusions (TRIs) in renal biopsies may be useful to raise diagnostic suspicion for certain clinical entities, particularly autoimmune diseases and viral infections. We report a case of a 65-year-old female with a 2-week history of malaise, massive proteinuria and lower extremity edema of acute onset. A renal biopsy was performed and the diagnosis of non-human immunodeficiency virus (HIV) tip-located, early focal segmental glomerulosclerosis (FSGS) was established. The electron microscopy examination was remarkable for the presence of diffuse foot process effacement and frequent TRIs in the endothelial cells of the glomerular capillary loops, endothelium of arterioles and cytoplasm of fibroblasts in the interstitium, highly suggestive of an underlying etiology. Patient clinical and laboratory workup revealed the absence of an autoimmune disease but the presence of a subclinical cytomegalovirus (CMV) infection. Therefore, we highlight that the identification of TRIs is a useful indicator of systemic interferon activity. In the present case, the unusual location of numerous TRIs was associated with a subclinical CMV infection in an immunocompetent patient.

No MeSH data available.


Related in: MedlinePlus