- Email: [email protected]
Renal outcomes in IGa nephropathy: validation of the oxford classification in the Thai population
S132
Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
to identify histo-morphological features in non-neoplastic kidney tissue. Methods: Renal tissue sections obtained from nephrectomy specimens (n ¼ 18) of patients with kidney tumors were imaged fresh with Olympus FV1000MPE system and submitted for histopathological diagnosis. Results: All the normal components of kidney were identified based on their unique signatures captured in different channels. Glomerular and tubular basement membrane (type IV collagen), tubular epithelial cells, lymphocytes, elastic lamina and media of the blood vessels had autoflourescence in short wavelength channel. Interstitial collagen (type I; normal and fibrotic), sclerosed glomeruli, tubular basement membrane thickening had unique SHG signal. Atrophic tubules with luminal cast, i.e., thyroidization of end-stage kidney had autofluorescence predominantly in long wavelength channel. MPM images were comparable histo-morphologically to their corresponding H&E images. Virtual sectioning while imaging allows threedimensional reconstruction of the tissue to assess architectural details. Conclusion: MPM can identify normal and abnormal histomorphological features associated with glomeruli and tubulo-interstitium. MPM could serve as a quick real-time imaging tool for evaluation of ex vivo kidney tissue both qualitatively and semiquantitatively.
Renal Pathology: Poster#301 RENAL OUTCOMES IN IGA NEPHROPATHY: VALIDATION OF THE OXFORD CLASSIFICATION IN THE THAI POPULATION Wisit Liwlompaisan1, Suchin Worawichawong2 and Chagriya Kitiyakara1 1Department of Internal Medicine, and 2Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand The Oxford classification of immunoglobulin A nephropathy (IgAN) was proposed to establish the risk of renal disease progression by specific pathologic features. This classification needs validation in different populations. A total of 126 patients with biopsy-proven IgAN at Ramathibodi Hospital between 2003 and 2012 with GFR above 30 mL/min/1.73m2 were enrolled in this retrospective study. The renal outcome was defined as the composite of 50% reduction in GFR and end state renal disease (ESRD). The Oxford classification was used to evaluate the pathologic lesions. The predictive values of clinicopathologic risk factors on renal survival were analyzed by univariate and multivariate models. The renal outcome occurred in 37 patients with median follow-up time of 49 months. Median renal survival was 121 months. In univariate time dependent analyses, only tubular atrophy/interstitial fibrosis was significantly associated with renal outcome. Other features such as crescentic lesions, mesangial hypercelluarity, endocapillary hypercelluarity, segmental glomerulosclerosis were not significant. In multivariate model, tubular atrophy/interstitial fibrosis (T1: HR 6.88, 95% CI 0.50–05.19; T2: HR 8.58, 95% CI 1.34– 54.82) were independent risk factor for renal outcome. We confirmed that tubulointerstitial features of the Oxford classification of IgAN can predict renal survival in the Thai population.
Renal Pathology: Poster#302 THE OUTCOME OF RENAL ALLOGRAFT C4D STAINING AMONG INDICATED BIOPSIES IN RAMATHIBODI HOSPITAL Atthapol Vanadaj1, Pitchaporn Kantachuvesiri1, Panas Chalermsanyakorn2, Surasak Kantachuvesiri1 and Suchin Worawichawong2 1Department of Internal Medicine, and 2Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand C4d is a footprint of complement activation and diffusely stained in endothelium of peritubular capillaries (PTC) of renal allograft significantly associated with antibody mediated rejection (AMR). Association with C4d staining and poor graft outcome has been reported but some show little effects. Kidney transplant patients with indicated kidney biopsies in Ramathibodi hospital (151 patients, 181 specimens) during 2010–2012 with follow up durations of 12–30 months were enrolled in this retrospective cohort study. Graft survival/outcome, demographic, clinical and histological data were recorded and correlated with PTC C4d staining and graft survival. PTC C4d deposition was detected in 38.12% of allograft biopsies. AMR was diagnosed in 47 specimens while 107 specimens show minimal histologic change. Univariate analysis shows that pathological factors associated with graft loss are peritubular capillaritis, interstitial fibrosis, tubular atrophy, transplant glomerulopathy, arteriolar hyalinosis and C4d staining. Multivariate analysis of survival analysis shows that C4d deposition associated with graft loss, HR 11.37 ( p ¼ 0.021, 95% CI 1.45–89.15). In patients without rejection, C4d deposition was still associated with worse prognosis (10.21 vs 0.62 events/1000 patient-month, p ¼ 0.012). Our study shows C4d positivity in 38% of indicated renal allograft biopsy and its significant association with poor renal allograft function and graft loss.
Surgical Pathology: Poster#303 A CASE STUDY OF PAPILLARY THYROID CARCINOMA IN A BACKGROUND HASHIMOTO THYROIDITIS WITH HURTHLE CELL METAPLASIA Chukwudi Okania, Benjamin S. Otenea, Terhemba Nyagaa, Joseph A. Ngbea1 and Eke B. Agaba2 1Department of Histopathology, and 2Department of Surgery, Benue State University Teaching Hospital Makurdi, Benue State, Nigeria Hashimoto thyroiditis (HT) is an autoimmune disease, known to be the most common cause of hypothyroidism in non-endemic goiterous areas. It is characterized by symmetric, painless and diffused but sometimes localized swelling of the thyroid gland with features of hypothyroidism. Papillary thyroid carcinoma (PTC), on the other hand, is the most common form of thyroid cancer in iodine deficient areas. The co-existence of the two diseases is possible but not common. This case study reports a 50-year-old female with a 10 year history of huge goitre which was symptom-free until 3 months prior to presentation when patient complained of neck pain, dysphagia, productive cough and cold intolerance. Examination revealed focal
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
to identify histo-morphological features in non-neoplastic kidney tissue. Methods: Renal tissue sections obtained from nephrectomy specimens (n ¼ 18) of patients with kidney tumors were imaged fresh with Olympus FV1000MPE system and submitted for histopathological diagnosis. Results: All the normal components of kidney were identified based on their unique signatures captured in different channels. Glomerular and tubular basement membrane (type IV collagen), tubular epithelial cells, lymphocytes, elastic lamina and media of the blood vessels had autoflourescence in short wavelength channel. Interstitial collagen (type I; normal and fibrotic), sclerosed glomeruli, tubular basement membrane thickening had unique SHG signal. Atrophic tubules with luminal cast, i.e., thyroidization of end-stage kidney had autofluorescence predominantly in long wavelength channel. MPM images were comparable histo-morphologically to their corresponding H&E images. Virtual sectioning while imaging allows threedimensional reconstruction of the tissue to assess architectural details. Conclusion: MPM can identify normal and abnormal histomorphological features associated with glomeruli and tubulo-interstitium. MPM could serve as a quick real-time imaging tool for evaluation of ex vivo kidney tissue both qualitatively and semiquantitatively.
Renal Pathology: Poster#301 RENAL OUTCOMES IN IGA NEPHROPATHY: VALIDATION OF THE OXFORD CLASSIFICATION IN THE THAI POPULATION Wisit Liwlompaisan1, Suchin Worawichawong2 and Chagriya Kitiyakara1 1Department of Internal Medicine, and 2Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand The Oxford classification of immunoglobulin A nephropathy (IgAN) was proposed to establish the risk of renal disease progression by specific pathologic features. This classification needs validation in different populations. A total of 126 patients with biopsy-proven IgAN at Ramathibodi Hospital between 2003 and 2012 with GFR above 30 mL/min/1.73m2 were enrolled in this retrospective study. The renal outcome was defined as the composite of 50% reduction in GFR and end state renal disease (ESRD). The Oxford classification was used to evaluate the pathologic lesions. The predictive values of clinicopathologic risk factors on renal survival were analyzed by univariate and multivariate models. The renal outcome occurred in 37 patients with median follow-up time of 49 months. Median renal survival was 121 months. In univariate time dependent analyses, only tubular atrophy/interstitial fibrosis was significantly associated with renal outcome. Other features such as crescentic lesions, mesangial hypercelluarity, endocapillary hypercelluarity, segmental glomerulosclerosis were not significant. In multivariate model, tubular atrophy/interstitial fibrosis (T1: HR 6.88, 95% CI 0.50–05.19; T2: HR 8.58, 95% CI 1.34– 54.82) were independent risk factor for renal outcome. We confirmed that tubulointerstitial features of the Oxford classification of IgAN can predict renal survival in the Thai population.
Renal Pathology: Poster#302 THE OUTCOME OF RENAL ALLOGRAFT C4D STAINING AMONG INDICATED BIOPSIES IN RAMATHIBODI HOSPITAL Atthapol Vanadaj1, Pitchaporn Kantachuvesiri1, Panas Chalermsanyakorn2, Surasak Kantachuvesiri1 and Suchin Worawichawong2 1Department of Internal Medicine, and 2Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand C4d is a footprint of complement activation and diffusely stained in endothelium of peritubular capillaries (PTC) of renal allograft significantly associated with antibody mediated rejection (AMR). Association with C4d staining and poor graft outcome has been reported but some show little effects. Kidney transplant patients with indicated kidney biopsies in Ramathibodi hospital (151 patients, 181 specimens) during 2010–2012 with follow up durations of 12–30 months were enrolled in this retrospective cohort study. Graft survival/outcome, demographic, clinical and histological data were recorded and correlated with PTC C4d staining and graft survival. PTC C4d deposition was detected in 38.12% of allograft biopsies. AMR was diagnosed in 47 specimens while 107 specimens show minimal histologic change. Univariate analysis shows that pathological factors associated with graft loss are peritubular capillaritis, interstitial fibrosis, tubular atrophy, transplant glomerulopathy, arteriolar hyalinosis and C4d staining. Multivariate analysis of survival analysis shows that C4d deposition associated with graft loss, HR 11.37 ( p ¼ 0.021, 95% CI 1.45–89.15). In patients without rejection, C4d deposition was still associated with worse prognosis (10.21 vs 0.62 events/1000 patient-month, p ¼ 0.012). Our study shows C4d positivity in 38% of indicated renal allograft biopsy and its significant association with poor renal allograft function and graft loss.
Surgical Pathology: Poster#303 A CASE STUDY OF PAPILLARY THYROID CARCINOMA IN A BACKGROUND HASHIMOTO THYROIDITIS WITH HURTHLE CELL METAPLASIA Chukwudi Okania, Benjamin S. Otenea, Terhemba Nyagaa, Joseph A. Ngbea1 and Eke B. Agaba2 1Department of Histopathology, and 2Department of Surgery, Benue State University Teaching Hospital Makurdi, Benue State, Nigeria Hashimoto thyroiditis (HT) is an autoimmune disease, known to be the most common cause of hypothyroidism in non-endemic goiterous areas. It is characterized by symmetric, painless and diffused but sometimes localized swelling of the thyroid gland with features of hypothyroidism. Papillary thyroid carcinoma (PTC), on the other hand, is the most common form of thyroid cancer in iodine deficient areas. The co-existence of the two diseases is possible but not common. This case study reports a 50-year-old female with a 10 year history of huge goitre which was symptom-free until 3 months prior to presentation when patient complained of neck pain, dysphagia, productive cough and cold intolerance. Examination revealed focal
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.