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- 病例二：老年男性，急性肾衰竭
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| 姓 名： | ××× | 性别： | 男 | 年龄： | 57 |
| 临床诊断： | 急性肾功能衰竭 | ||||
| 简要病史： | “感冒”4天后•出现无尿、乏力、恶心、呕吐，胸闷、气短，血常规及血生化示“白细胞17.53*109/L，红细胞4.25*1012/L，血小板68*1012/L；尿素氮10.70mmol/L，肌酐337umol/L”，B超示双肾大小正常，实质回声增强。 • ANCA、自身抗体、抗GBM抗体（-）。 | ||||
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本帖最后由 于 2010-01-11 12:26:00 编辑
×参考诊断
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Thank you, 清静无为, for posting this interesting cast. Just based on the above paraffin sections, I identified the following changes: 1) diffuse tubular dilatation, suggestive of acute tubular injury; 2) the red cell or ? casts, but I am not sure if they are related to the biopsy procedure; 3) Some of the glomerular capillary lumens are narrowed, with occasional double contour. At this stage, ATN vs glomerular disease is my differential diagnosis. Please let us know the results of the immunofluorescence microscopy and electron microscopy. Thank you again.
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Thanks for the IF and EM results. The IF is non-specific. The EM shows marked subendothelial space widening, without electron dense deposits. There is cytoplasmic process in EM photo 1. I am doubt that this is real mesangial interposition. The patient's history is too short to have mesangial interposition. Also it is sligtly too large to be counted as cellular debris. My impression is that this is thrombotic microangiopathy. The ATN is secondary. 血小板 (68*1012) is decreased, isn't it?
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本帖最后由 于 2010-01-12 13:14:00 编辑
| 以下是引用quhong在2010-1-12 3:03:00的发言： Thanks for the IF and EM results. The IF is non-specific. The EM shows marked subendothelial space widening, without electron dense deposits. There is cytoplasmic process in EM photo 1. I am doubt that this is real mesangial interposition. The patient's history is too short to have mesangial interposition. Also it is sligtly too large to be counted as cellular debris. My impression is that this is thrombotic microangiopathy. The ATN is secondary. 血小板 (68*1012) is decreased, isn't it? |
Yes, You are right! 
The diagnosis is thrombotic microangiopathy (thrombotic thrombocytopenic purpura, TTP).
EM changes is very typical.
