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  #1  
Old 09-21-2012
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Kidney Apple-Green Birefringence on Congo Red Stain!

A renal pathologist examining the day's kidney biopsies notes that one biopsy shows amorphous red nodules within the glomerular mesangium in hematoxylin and eosin stained material. Congo red stain of the biopsy demonstrates apple-green birefringence of these nodules. These nodules are most likely to be related to which of the following?

A. Acute urinary tract infection
B. Diabetes mellitus
C. Sarcoidosis
D. Systemic lupus erythematosus
E. Tuberculosis
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  #2  
Old 09-21-2012
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i'll go with B) diabetes mellitus
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Old 09-21-2012
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Default my answer :)

E. Tuberculosis

Congo red + apple-green birefringence = amyloid -> 2ndary too chronic inflammation-> TB
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Old 09-21-2012
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I would choose TB
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Old 09-21-2012
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Help ...

I am confused between Diabetes and Tuberculosis!
But I will go with Tuberculosis
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Old 09-21-2012
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Default Diabetes mellitus

mesangium (location)+ amyloid deposits (may be ) = DM
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Old 09-21-2012
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E

TB
chronic inflammatory processes lead to deposition of amyloid
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Old 09-21-2012
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BB..Diabetes mellitus

diabetics also have amyloid deposits and presence of mesangial deposits of KW nodules
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Old 09-21-2012
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mmm i will go with D.M
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Quote:
Originally Posted by blade View Post
BB..Diabetes mellitus

diabetics also have amyloid deposits and presence of mesangial deposits of KW nodules
Thats glomerulosclerosis not amyloid deposition
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  #11  
Old 09-21-2012
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'with amorphous red nodules in mesangium' (most likely KW nodule), i will go for
BB. Diabetes mellitus
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  #12  
Old 09-21-2012
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amyloid is just fibrous insoluble aggregates proteins . so in any case of increasing unnecessary proteins (excess ) like in any CHRONIC INFLAMATORY were we have too much acute phase proteins , some will tend aggregate and lead to amyloid . so from choices , look and search where is chronic inflamation ? for sure simply and easy is TB . will go with E .
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Old 09-21-2012
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and DM can be answer here , but dasnt match with amyloid location in DM , because in DM amyloid deposition is in pancrease , and not in kidney as question say . so we have amyloid but not as decribed above .
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Old 09-21-2012
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Quote:
Originally Posted by koyi View Post
amyloid is just fibrous insoluble aggregates proteins . so in any case of increasing unnecessary proteins (excess ) like in any CHRONIC INFLAMATORY were we have too much acute phase proteins , some will tend aggregate and lead to amyloid . so from choices , look and search where is chronic inflamation ? for sure simply and easy is TB . will go with E .
if chronic inflamation...even sarcoidosis qualifies.. right?
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  #15  
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TB ( chronic inflammatory condition )
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Quote:
Originally Posted by koyi View Post
and DM can be answer here , but dasnt match with amyloid location in DM , because in DM amyloid deposition is in pancrease , and not in kidney as question say . so we have amyloid but not as decribed above .
@koyi,so whats the mesangial deposit??
its obviously DM

pls can you post the answer @ Fuser
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Old 09-21-2012
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@pollex , well sracoidosis can be acute , subacute , or chronic as u said . but our question dasnt show us any direction of judgement on ths abt acute or chronic sarcoidosis here , and even though u will associate sarcoidosis wth amyloidosis by general idea of chronic inf , there is less association of ths , and even if happen tends be more localized in those places affected mostly with sarcoidosis like lungs , liver skin and heart may be , but not or less commonly kidney . third , if u look the question is asking most likely ans , and ths means u have to think typicaly and most commonly as STEP 1 curriculum say . so is just easy to pick TB because is typicaly chronic inflamation , and also wth great tendency of dissemination to viscerals ( as u see in milliary TB ) . thats what i came to conclusion of ans E (TB) and not sarcoidosi or DM .
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@chux , i wanted think that they are kimmelstiel nodules (connected wth DM ) but the trick here i see is qn say they are congo +ve and amorphous . but kimmelstiel nodules , are congo -ve and amorphous . yar qn what are these deposits ? if are not DM nodules , and are congo + , amorphous , for sure are nothing else but Amyloidosis deposit .
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Correct Answer The correct answer is E

Glomerular nodules may be either the Kimmelstiel-Wilson nodules of diabetes mellitus or may be composed of amyloid. An amyloid origin can be confirmed by staining with Congo red, which causes the nodules to stain red with ordinary light but exhibit a distinctive "apple-green" birefringence when viewed with polarized light. The most common type of amyloid (type AA) is due to deposition of altered immunoglobulin light chains and is seen in diseases with chronic antigenic stimulation, such as tuberculosis.

Acute urinary tract infection (choice A) is an infection of too short a duration to cause amyloidosis.

Diabetic mellitus (choice B) is associated with glomerular nodules called Kimmelstiel-Wilson nodules, but these will not show apple-green birefringence when viewed with polarized light.

Sarcoidosis (choice C) typically involves the lymph nodes, lungs, spleen, and to a lesser extent, the skin and eye. It is unrelated to amyloidosis.

Systemic lupus erythematosus (choice D) can produce a wide range of renal lesions, but amyloid nodules are not among the likely manifestations
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