檢體:U
COLOR Yellow
TURBIDITY Clear
SP.GRAVITY 1.013
PH 6.5
LEUKOCYTE cell/uL Negative
NITRITE mg/dL Negative
PROTEIN mg/dL 3+ (300) ** mg/dl
GLUCOSE mg/dL Negative
KETONE mg/dL Negative
UBG EU/dL 0.1
BILIRUBIN mg/dL Negative
BLOOD cell/uL 3+ (200) ** cell/ul
RBC /uL 305 ** /ul
WBC /uL 0
SQUAMUS /uL 0
眼見自己念高職的大兒子己經在洗腎，看到二兒子的抽血報告，媽媽心中衝擊之大，可想而知。一開始二兒子在別診所追蹤，媽媽後來問我腎臟切片是否一定要做？我的回答是當然，因為一般的自體免疫抗體檢查都找不出病因，也沒有藥物或是感染因素在其中，當然要做腎臟切片，看是否有特殊病因？才能使用免疫抑制劑來對症治療。
腎臟切片報告：局部性腎絲球硬化症(Focal segmental glomerulosclerosis, FSGS)
以下是FSGS在H&E stain
以下是FSGS在H&E stain
這是一個難治的腎臟疾病，需要好好的配合醫療，才能避免掉將來的腎臟衰竭。想到這年輕人，還有他己經在洗腎的哥哥（並沒有做腎臟切片，所以不知原發病因），FSGS少數是因有家族性基因的異常(杜克大學基因研究)。他們兄弟倆是否是同一病？現在己經不可考了，只是希望這弟弟的病情能得到控制而穩定下來。
附上腎臟切片H&E STAIN、免疫螢光和電子顯微鏡報告
DX:
KIDNEY, BIOPSY
---- FOCAL SEGMENTAL GLOMERULOSCLEROSIS, CONSISTENT WITH
ADDENDUM:
IF STUDY (IF2010=48)
THERE ARE 2 GLOMERULI ON THE IMMUNOFLUORESCENCE STUDY SECTIONS.
CAPILLARY LOOP MESANGIUM
IgG (-) (-)
IgA (-) (-)
IgM (1+, G, F) (1+, G, F)
C3 (1+, G, F) (-)
C4 (-) (-)
C1q (-) (-)
FIBRINOGEN (2+, L, S) (-)
KAPPA: (-) (-)
LAMBDA: (-) (-)
GROSS D:
THE SPECIMEN SUBMITTED CONSISTS OF 3 CORES OF RENAL TISSUE FRAGMENTS
MEASURING UP TO 1.0 CM IN LENGTH. THEY ARE DIVIDED INTO 3 PARTS. ONE IS
FROZEN FOR IMMUNOFLUORESCENCE STUDY (0.5 CM IN LENGTH); ONE IS FIXED IN
GLUTARALDEHYDE FOR ELECTRON MICROSCOPIC STUDY (0.2 CM IN LENGTH); THE
REST IS FIXED IN FORMALIN FOR ROUTINE H&E STAIN AND OTHER SPECIAL STAINS.
MICRO D:
THERE ARE 2-5 GLOMERULI ON THE SECTION. NONE OF THEM IS COMPLETELY
SCLEROTIC.
GLOMERULI:
1. CAPILLARY LOOPS:
a. MOST ARE DELICATE AND THIN
b. IRREGULAR THICKENING IN FOCAL AREA
c. PAM STAIN: HETEROGENEOUS STAINING
2. MESANGIUM:
a. MESANGIAL CELL PROLIFERATION: PRESENT OCCASIONALLY
b. MESANGIAL MATRIX: SLIGHTLY INCREASED
c. PAS STAIN: NEUTROPHIL: ABSENT
3. LOBULAR ARCHITECTURE: EXAGGERATED, FOCALLY
4. SEGMENTAL PROLIFERATING AND SCLEROSING LESIONS ARE IDENTIFIED
IN ONE GLOMERULUS WITH ATTACHMENT OT THE BOWMAN'S CAPSULE.
5. CRESCENT: ABSENT
TUBULES:
1. VACUOLIZATION OF THE EPITHELIUM: PRESENT OCCASIONALLY
2. ATROPHY: PRESENT (30 % OF THE TUBULES)
3. NECROSIS OF EPITHELIUM: PRESENT OCCASIONALLY
4. THYROIDIZATION: ABSENT
5. CASTS: HYALINE
INTERSTITIUM:
1. FIBROSIS: SEVERE (50% OF THE INTERSTITIUM)
2. ACUTE AND CHRONIC INFLAMMATORY CELL INFILTRATION:
SEVERE (50% OF THE INTERSTITIUM)
3. FOAMY CELLS: PRESENT FOCALLY
VESSELS:
1. UNREMARKABLE
KIDNEY, BIOPSY
---- FOCAL SEGMENTAL GLOMERULOSCLEROSIS, CONSISTENT WITH
ADDENDUM:
IF STUDY (IF2010=48)
THERE ARE 2 GLOMERULI ON THE IMMUNOFLUORESCENCE STUDY SECTIONS.
CAPILLARY LOOP MESANGIUM
IgG (-) (-)
IgA (-) (-)
IgM (1+, G, F) (1+, G, F)
C3 (1+, G, F) (-)
C4 (-) (-)
C1q (-) (-)
FIBRINOGEN (2+, L, S) (-)
KAPPA: (-) (-)
LAMBDA: (-) (-)
GROSS D:
THE SPECIMEN SUBMITTED CONSISTS OF 3 CORES OF RENAL TISSUE FRAGMENTS
MEASURING UP TO 1.0 CM IN LENGTH. THEY ARE DIVIDED INTO 3 PARTS. ONE IS
FROZEN FOR IMMUNOFLUORESCENCE STUDY (0.5 CM IN LENGTH); ONE IS FIXED IN
GLUTARALDEHYDE FOR ELECTRON MICROSCOPIC STUDY (0.2 CM IN LENGTH); THE
REST IS FIXED IN FORMALIN FOR ROUTINE H&E STAIN AND OTHER SPECIAL STAINS.
MICRO D:
THERE ARE 2-5 GLOMERULI ON THE SECTION. NONE OF THEM IS COMPLETELY
SCLEROTIC.
GLOMERULI:
1. CAPILLARY LOOPS:
a. MOST ARE DELICATE AND THIN
b. IRREGULAR THICKENING IN FOCAL AREA
c. PAM STAIN: HETEROGENEOUS STAINING
2. MESANGIUM:
a. MESANGIAL CELL PROLIFERATION: PRESENT OCCASIONALLY
b. MESANGIAL MATRIX: SLIGHTLY INCREASED
c. PAS STAIN: NEUTROPHIL: ABSENT
3. LOBULAR ARCHITECTURE: EXAGGERATED, FOCALLY
4. SEGMENTAL PROLIFERATING AND SCLEROSING LESIONS ARE IDENTIFIED
IN ONE GLOMERULUS WITH ATTACHMENT OT THE BOWMAN'S CAPSULE.
5. CRESCENT: ABSENT
TUBULES:
1. VACUOLIZATION OF THE EPITHELIUM: PRESENT OCCASIONALLY
2. ATROPHY: PRESENT (30 % OF THE TUBULES)
3. NECROSIS OF EPITHELIUM: PRESENT OCCASIONALLY
4. THYROIDIZATION: ABSENT
5. CASTS: HYALINE
INTERSTITIUM:
1. FIBROSIS: SEVERE (50% OF THE INTERSTITIUM)
2. ACUTE AND CHRONIC INFLAMMATORY CELL INFILTRATION:
SEVERE (50% OF THE INTERSTITIUM)
3. FOAMY CELLS: PRESENT FOCALLY
VESSELS:
1. UNREMARKABLE
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