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Renal juxtaglomerular apparatus hyperplasia

Renal juxtaglomerular apparatus hyperplasia A 33-year-old woman with pulmonary artery hypertension diagnosed 20 months previously, right heart failure, acute on chronic renal failure with creatinine of 4.7, and mild proteinuria, presented for renal biopsy to rule out lupus nephritis. Laboratory data included FANA positive at 1:1280 (homogeneous), positive anti-DNA antibodies at 1:320 and SSA (Ro) antibody positive at 192. The biopsy demonstrated no evidence of immune complex-mediated disease, but instead revealed changes of chronic ischaemia including diffuse interstitial fibrosis with tubular atrophy. Glomeruli were enlarged, many with ischaemic retraction of the tuft, along with mild mesangial widening and increased mesangial cellularity. The most striking feature was marked juxtaglomerular apparatus (JGA) hyperplasia throughout the biopsy (Figure 1), in response to chronic systemic hypotension [1,2]. Fig. 1. Open in new tabDownload slide The patient's biopsy. The large arrow indicates the JGA, the arrowhead shows the macula densa and the small arrow indicates renin granules within the JGA. Original magnification 400× left, 600× right. Fig. 1. Open in new tabDownload slide The patient's biopsy. The large arrow indicates the JGA, the arrowhead shows the macula densa and the small arrow indicates renin granules within the JGA. Original magnification 400× left, 600× right. Conflict of interest statement. None declared. (Section Editor: G. H. Neild) References 1 Venkatachalam MA, Kriz W. Anatomy: juxtaglomerular apparatus. In: Jennette JC, Olson, JL, Schwartz MM, Silva FG, eds. Heptinstall's Pathology of the Kidney , 5th edn. Lippincott-Raven, Philadelphia; 1998 : 49 –52 2 Bohle A, Christensen J, Meyer DS, Laberke HG, Strauch M. Juxtaglomerular apparatus of the human kidney: correlation between structure and function. Kidney Int Suppl 1982 ; 12 : S18 –S23 Author notes 1Department of Pathology and 2Division of Nephrology, Stanford University Medical Center, Stanford, CA, USA, 3Present address: Department of Pathology, Oregon Health and Science University, Portland, OR, USA © The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Nephrology Dialysis Transplantation Oxford University Press

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References (3)

Publisher
Oxford University Press
Copyright
© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
ISSN
0931-0509
eISSN
1460-2385
DOI
10.1093/ndt/gfh883
pmid
15941848
Publisher site
See Article on Publisher Site

Abstract

A 33-year-old woman with pulmonary artery hypertension diagnosed 20 months previously, right heart failure, acute on chronic renal failure with creatinine of 4.7, and mild proteinuria, presented for renal biopsy to rule out lupus nephritis. Laboratory data included FANA positive at 1:1280 (homogeneous), positive anti-DNA antibodies at 1:320 and SSA (Ro) antibody positive at 192. The biopsy demonstrated no evidence of immune complex-mediated disease, but instead revealed changes of chronic ischaemia including diffuse interstitial fibrosis with tubular atrophy. Glomeruli were enlarged, many with ischaemic retraction of the tuft, along with mild mesangial widening and increased mesangial cellularity. The most striking feature was marked juxtaglomerular apparatus (JGA) hyperplasia throughout the biopsy (Figure 1), in response to chronic systemic hypotension [1,2]. Fig. 1. Open in new tabDownload slide The patient's biopsy. The large arrow indicates the JGA, the arrowhead shows the macula densa and the small arrow indicates renin granules within the JGA. Original magnification 400× left, 600× right. Fig. 1. Open in new tabDownload slide The patient's biopsy. The large arrow indicates the JGA, the arrowhead shows the macula densa and the small arrow indicates renin granules within the JGA. Original magnification 400× left, 600× right. Conflict of interest statement. None declared. (Section Editor: G. H. Neild) References 1 Venkatachalam MA, Kriz W. Anatomy: juxtaglomerular apparatus. In: Jennette JC, Olson, JL, Schwartz MM, Silva FG, eds. Heptinstall's Pathology of the Kidney , 5th edn. Lippincott-Raven, Philadelphia; 1998 : 49 –52 2 Bohle A, Christensen J, Meyer DS, Laberke HG, Strauch M. Juxtaglomerular apparatus of the human kidney: correlation between structure and function. Kidney Int Suppl 1982 ; 12 : S18 –S23 Author notes 1Department of Pathology and 2Division of Nephrology, Stanford University Medical Center, Stanford, CA, USA, 3Present address: Department of Pathology, Oregon Health and Science University, Portland, OR, USA © The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Journal

Nephrology Dialysis TransplantationOxford University Press

Published: Oct 1, 2005

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