Journal of nephropathology
Volume:11 Issue: 3, Jul 2022

HIV-related renal diseases have become more evident and easier to treat due to the prolonged survival of patients with HIV infection on antiretroviral therapy (ART). There are multiple factors involved in the pathogenesis of this entity. However, very little has been described regarding secondary membranoproliferative glomerulonephritis and especially a crescentic disease in these patients. Herein, we describe a patient who was incidentally detected to have HIV infection while evaluating for a rapidly progressive renal failure and was detected to have crescentic glomerulonephritis. We have reviewed the literature pertinent to the case in the present report.

Identification of electron-dense immune deposits in electron microscopy (EM) images is integral to the diagnosis of medical renal disease. Deep learning has the potential to augment this process, especially in areas with limited resources.

Our study explores the feasibility of applying deep learning to detect electron dense immune deposits in electron microscopy images from medical renal biopsies.

EM images (N=900) from native and transplant kidney biopsies were processed into 4530 tiles (512 x 512 pixels). These tiles were reviewed and classified into one of three categories: deposits absent, deposits present, and indeterminate. This classification resulted in 1255 images with consensus agreement for deposits present and deposits absent. These 1255 images were then used to train a machine learning model, using 1006 images for training, and 249 images for testing.

The overall accuracy on the test data was a competitive 78%, and the F1 scores for deposits absent and present was 0.76 and 0.79, respectively.

This study demonstrated the feasibility of creating and applying a machine learning model that performs competitively in identifying electron dense deposits in EM images.

It is well-known that metabolic syndrome is a pathophysiological state with increased risks for diabetes mellitus (DM) and the atherosclerotic cardiovascular disease. Moreover, hyperuricemia can be considered as the main component in metabolic syndrome.

The present research aimed at the investigation of the association between serum level of uric acid with metabolic syndrome parameters.

The present cross-sectional study population consisted of 200 subjects susceptible to metabolic syndrome. Data related to weight, height, waist circumference, body mass index (BMI), history of the disease, as well as drug consumption were recorded. All patients underwent routine blood tests for C-reactive protein (CRP ) as well as uric acid levels. According to the diagnostic criteria for metabolic syndrome, we divided the patients into two groups. The first group was affected by metabolic syndrome(case) and the second was without metabolic syndrome (control). Then, we utilized Pearson’s correlation coefficient to investigate the correlation of the serum level of uric acid with the continuous metabolic syndrome parameters. Finally, significant level was P<0.05 throughout this survey.

In the case group, the level of uric acid was higher (6.55 ± 1.24 mg/dL) than the control level (4.76 ± 1.24 mg/dL) (P<0.001). We found a significant correlation between the uric acid level and hip circumference, waist circumference, fasting blood sugar, and CRP only in obese patients.

As demonstrated, a positive association between the level of serum uric acid and BMI ≥30 kg/m2 in the case group suggests greater role of obesity in metabolic syndrome. Since there is a strong correlation between serum CRP and uric acid levels in the case group with BMI ≥30 kg/m2 . High plasma concentration of uric acid can be an inflammatory marker and risk factor for obesity. Therefore, obese people with metabolic syndrome are recommended to control their hyperuricemia.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that can involve various organs. Renal involvement has been seen in about 60% of SLE patients, while the most common presentation of lupus nephritis (LN) is proteinuria.

This study aimed to investigate the clinical and laboratory features of LN patients, confirmed by kidney biopsy and compare these among different classes of LN.

This cross-sectional study was conducted on clinical and laboratory data of patients with LN from 2001 to 2016. All patients diagnosed with definite LN by biopsy and electron microscopy (EM) were included in this study.

A total number of 496 patients were enrolled. The mean age of all patients was 28.32 ±11.41 years; 82.4% (409) were females. The biopsies were classified into LN classes II, III, IV, V, and VI, whose frequencies were 98 (20.6%), 93 (19.5%), 225(47.3%), 46 (9.7%), and 14 (2.9%), respectively. Tubular atrophy (P<0.001) and interstitial fibrosis (P<0.001) were found to be significantly associated with classes of LN. Additionally, 72.7% (8) and 48.2% (92) of patients in classes Ⅵ and Ⅳ of LN had blood urea nitrogen (BUN) levels more than the normal range (P< 0.001). Regarding serum creatinine levels, 81.8% (9) and 42.9% (81) of patients in classes Ⅵ and Ⅳ of LN had high levels (P<0.001). Moreover, nephrotic syndrome (NS) was reported in 47.5% (47) of patients with class Ⅱ of LN followed by 38.8% (36) in class Ⅲ. Besides, edema was significantly more dominant in classes Ⅳ (74.3%, 133) and VI (75%) of LN patients (P=0.03).

Tubular atrophy and interstitial fibrosis were more commonly seen in LN class Ⅵ followed by class IV. Edema, hypertension, and proteinuria are common presentations in class IV. Complete assessment of renal biopsy is still helpful for the definite classification of LN.

Implication for health policy/practice/research/medical education:

 Clinicopathologic correlations in lupus nephritis (LN) have traditionally provided the basis for pathologic classification of the disease on renal biopsy. However, these correlations are not perfect. Although renal biopsy is considered the gold standard for diagnosing and classifying LN, it suffers from inherent shortcomings and drawbacks. The currently used ISN/RPS classification is mainly based on morphology and is glomerulocentric in outlook. Given the imperfections of ISN/RPS classification of LN, the future lies in the integration of traditional morphology with clinical, genetic and molecular markers to classify the disease more accurately and make the biopsy report more informative for choosing best treatment, to predict the response to treatment and to prognosticate the course of disease in an individual patient.

Please cite this paper as: 

Mubarak M. Beyond clinicopathologic correlations in lupus nephritis: Future lies in molecular-based composite classification. J Nephropathol. 2022;11(3):e17148. DOI: 10.34172/jnp.2022.17148.

Type II mixed cryoglobulinemia is a systemic disease mediated by immune complexes. Renal involvement is present in almost one third of the cases and the membranoprolifer-ative pattern is the most common histological presentation. In turn, in Waldenström macroglobulinemia, renal impairment is rare, with few cases of associated cryoglobu-linemia being reported. The authors present the case of a patient with type II mixed cry-oglobulinemia associated with Waldenström macroglobulinemia diagnosis.