scholarly journals A reevaluation of routine electron microscopy in the examination of native renal biopsies.

1997 ◽  
Vol 8 (1) ◽  
pp. 70-76
Author(s):  
M Haas
Keyword(s):  
Electron Microscopy ◽  
Lupus Nephritis ◽  
Light Microscopy ◽  
Final Diagnosis ◽  
Preliminary Diagnosis ◽  
Ultrastructural Studies ◽  
Collapsing Glomerulopathy ◽  
Postinfectious Glomerulonephritis ◽  
Renal Biopsies ◽  
Made In

Electron microscopy is routinely utilized in most centers in the evaluation of native renal biopsies. Several studies, primarily from the 1960s and early 1970s, provide justification for its use. Conducted by Siegel et al. (1), the largest study evaluated 213 consecutive renal biopsies and found that electron microscopy was needed for a correct diagnosis in 11%, as well as for confirmation or additional information in another 36%. However, nearly all of these studies were conducted before the use of immunofluorescence in renal biopsy diagnosis became widespread and before several new glomerular diseases and variants were described. In light of this situation and the expense of the procedure, the routine use of electron microscopy in native renal biopsies also examined by immunofluorescence and routine light microscopy was reevaluated. From January 1996 to June 1996, 288 native renal biopsies were received, and all were evaluated by the same pathologist. Of those, 233 met criteria for inclusion in this study, which were > or = 5 glomeruli for light microscopy, > or = 2 for immunofluorescence, and > or = 1 for electron microscopy, not including globally scarred glomeruli. Light microscopy (hematoxylin and eosin, periodic acid-Schiff stains) and immunofluorescence--for immunoglobulin (Ig) G, IgA, IgM, C3, C1q, fibrinogen; kappa/lambda when needed--were evaluated on each biopsy within 48 h of receipt, and a preliminary diagnosis was recorded if possible. Electron microscopy was then performed, and a final diagnosis was made. In 50 cases (21%), electron microscopy was needed to make the final diagnosis; in two of these cases, the preliminary diagnosis was incorrect, and in 48, a firm preliminary diagnosis could not be made. In the other cases, the preliminary diagnosis was correct, but in 48 (21%), ultrastructural study was felt to provide important confirmatory data, and in eight cases (3%), an additional, unrelated diagnosis was supported by the ultrastructural findings. Diagnoses most frequently requiring electron microscopy included minimal change nephropathy, early diabetic nephropathy, membranous lupus nephritis, membranoproliferative glomerulonephritis, postinfectious glomerulonephritis, thin basement membrane nephropathy (or exclusion of this in cases of otherwise unexplained hematuria), and human immunodeficiency virus-associated nephropathy (or exclusion of it in cases of collapsing glomerulopathy). Common diagnoses usually not requiring electron microscopy included IgA nephropathy, diffuse proliferative lupus nephritis, focal segmental glomerulosclerosis (not collapsing glomerulopathy variant), pauci-immune crescentic glomerulonephritis, acute interstitial nephritis, and amyloid nephropathy. This study confirms that, as was the case 20 to 30 yr ago, electron microscopy provides useful diagnostic information in nearly half of native renal biopsies. If electron microscopy cannot be performed routinely on all such biopsies, it is recommended that tissue for ultrastructural studies be set aside in each case.

Sclerosing Glomerulonephritis

1975 ◽  
Vol 33 ◽  
pp. 408-409
Author(s):  
A. Mandal ◽  
K. Chrysant ◽  
J. Nordquist ◽  
S. Kraikitpanitch ◽  
D. Xoung ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Renal Failure ◽  
Retrospective Study ◽  
Light Microscopy ◽  
Membranous Glomerulonephritis ◽  
Chronic Glomerulonephritis ◽  
Previous Diagnosis ◽  
Renal Biopsies ◽  
End Stage ◽  
Made In

A small but undefined percentage of adults with idiopathic proteinuria, microscopic hematuria and hypertension with partial or no response to corticosteroid or immunosuppressive therapy, progress slowly to renal failure. Histological diagnosis of membranous, membranoproliferative or chronic glomerulonephritis were made in these patients. Retrospective reevaluation of renal pathology in such patients has resulted in the emergence of a new clinicopathological entity. We are reporting a retrospective study of renal biopsies using light microscopy (LM) and electron microscopy (EM) from six patients with previous diagnosis of proliferative glomerulonephritis (2 patients), membranous glomerulonephritis (2 patients), nephrosclerosis (1 patient) and end stage kidney (1 patient). These patients were aged between l6 and 51 years, four males and two females. They had initial average 24 hour proteinuria of 1.3 gm (range 0.5-3.4 gm) and blood urea nitrogen of 24 mgm percent (range 12-32 mgm percent).

scholarly journals The role of electron microscopy for the diagnosis of glomerulopathies

2004 ◽  
Vol 122 (3) ◽  
pp. 104-109 ◽  
Author(s):  
Angelo Sementilli ◽  
Luiz Antonio Moura ◽  
Marcello Fabiano Franco
Keyword(s):  
Electron Microscopy ◽  
Light Microscopy ◽  
Laboratory Data ◽  
Final Diagnosis ◽  
Glomerular Diseases ◽  
Financial Pressure ◽  
Renal Biopsies ◽  
Morphological Diagnosis ◽  
Selection Of

CONTEXT: Electron microscopy has been used for the morphological diagnosis of glomerular diseases for more than three decades and its value has been widely emphasized. However, recent reports have analyzed the routine use of electron microscopy critically. Its use in other areas of diagnosis such as tumor diseases has declined considerably; in addition, in view of the unavoidable financial pressure for the reduction of costs due to investigations and diagnostic routines, the selection of cases for electron microscopy has been quite rigorous. OBJECTIVE: To identify the glomerular diseases that depend on electron microscopy for a final diagnosis, by means of reviewing renal biopsies performed over a 12-year period. DESIGN: Prospective SETTING: Hospital Ana Costa, Hospital Guilherme Álvaro and Serviço de Anatomia Patológica de Santos, Santos, São Paulo, Brazil. PARTICIPANTS: 200 consecutive renal biopsies obtained from private hospitals and the teaching hospital from 1979 to 1991 were studied. MAIN MEASUREMENTS: All cases were analyzed via light microscopy, immunofluorescence and electron microscopy. The diagnosis was first made via light microscopy plus immunofluorescence and then via electron microscopy. RESULTS: Electron microscopy was diagnostic or essential for diagnosis in 10.0% of the cases, corresponding to 3.4% of primary glomerulopathies and 100% of hereditary glomerulopathies. Electron microscopy was contributory (useful) to the diagnosis in 5.5% of the cases, confirming the preliminary diagnosis formulated on the basis of clinical and laboratory data and light microscopy plus immunofluorescence findings. We obtained a 7.5% rate of discordant immunofluorescence, which was considered as such when negative immunofluorescence findings were not confirmed by electron microscopy. The final diagnosis with the use of light microscopy plus immunofluorescence alone was 77.0%. CONCLUSIONS: It was possible to diagnose with certainty a great percentage of glomerulopathies (82.5-90% of the cases) based on the light microscopy and immunofluorescence findings alone. Electron microscopy was essential for the diagnosis of hereditary nephropathies.

scholarly journals The Continuing Need for Electron Microscopy in Examination of Medical Renal Biopsies: Examples in Practice

2021 ◽  
pp. 1-15
Author(s):  
Michifumi Yamashita ◽  
Mercury Y. Lin ◽  
Jean Hou ◽  
Kevin Y.M. Ren ◽  
Mark Haas
Keyword(s):  
Electron Microscopy ◽  
Renal Biopsy ◽  
Renal Allograft ◽  
Comprehensive Evaluation ◽  
Diagnostic Value ◽  
Ultrastructural Studies ◽  
The Past ◽  
Biopsy Diagnosis ◽  
Renal Biopsies ◽  
Clinical Consequences

<b><i>Background:</i></b> For the better part of the past 6 decades, transmission electron microscopy (EM), together with routine light microscopy and immunofluorescence and/or immunohistochemistry (IHC), has been an essential component of the diagnostic workup of medical renal biopsies, particularly native renal biopsies, with increasing frequency in renal allograft biopsies as well. Studies performed prior to the year 2000 have indeed shown that a substantial fraction of renal biopsies cannot be accurately diagnosed without EM. Still, EM remains costly and labor-intensive, and with increasing pressure to reduce healthcare costs, some centers are de-emphasizing diagnostic EM. This trend has been coupled with advances in IHC and other methods in renal biopsy diagnosis over the past 2–3 decades. <b><i>Summary:</i></b> Nonetheless, it has been our experience that the diagnostic value of EM in the comprehensive evaluation of renal biopsies remains similar to what it was 20–30 years ago. In this review, we provide several key examples from our practice where EM was essential in making the correct renal biopsy diagnosis, ranging from relatively common glomerular lesions to rare diseases. <b><i>Key Messages:</i></b> EM remains an important component of the diagnostic evaluation of medical renal biopsies. Failure to perform EM in certain cases will result in an incorrect diagnosis, with possible clinical consequences. We strongly recommend that tissue for EM be taken and stored in an appropriate fixative and ultrastructural studies be performed for all native renal biopsies, as well as appropriate renal allograft biopsies as recommended by the Banff consortium.

Electron microscopy study of 496 cases of lupus nephritis: A single-center experience

Lupus ◽  
2021 ◽  
pp. 096120332098453
Author(s):  
Bahar Bagheri ◽  
Seyed Mohammad Owji ◽  
Simin Torabinezhad ◽  
Hadi Raeisi Shahraki ◽  
Amirhossein Kamalinia ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Lupus Nephritis ◽  
Light Microscopy ◽  
Lupus Erythematosus ◽  
Interstitial Fibrosis ◽  
Renal Involvement ◽  
Correct Classification ◽  
Tubular Atrophy ◽  
Diagnosis And Classification

Introduction Renal involvement is seen in about 40-82% of systemic lupus erythematosus (SLE) Asian patients. The exact diagnosis and classification of lupus nephritis are important for treatment and prognosis. This study aimed to investigate the value of electron microscopy (EM) in the diagnosis and classification of lupus nephritis compared with light microscopy. Method In this cross-sectional referral-center 16-year study of lupus nephritis, the final diagnosis was based on the EM study. Primary light microscopy findings were compared with EM diagnosis. Moreover, Immunofluorescence patterns distribution was assessed. Results From 496 patients diagnosed with lupus nephritis based on EM, 225(45.4%) of patients were categorized in class IV, followed by 98(19.7%), 93(18.8%), 46(9.3%), and 14(2.8%) who were categorized into classes of II, III, V, and VI respectively. Only 1(0.2%) patient belonged to class I, and 19(3.8%) cases were diagnosed with mixed two classes. Using EM was essential for diagnosing 25.6% of cases taking the correct classification by light microscopy into account; however, disregarding correct classification, this could change to a 7.4% contribution rate of EM. The most common cause of misdiagnosis, disregarding incorrect classification, was inadequate or wrong tissue. Positive associations were detected between tubular atrophy and interstitial fibrosis of both electron and light microscopy with different classes (P < 0.001). Conclusion While light microscopy is highly accurate for diagnosing lupus nephritis regardless of correct classification, EM contributes substantially to the correct classification of lupus nephritis types.

Electron Microscopy in the Diagnosis of Liposarcoma and Fibrosarcoma of the Larynx

1979 ◽  
Vol 88 (6) ◽  
pp. 867-871 ◽  
Author(s):  
David N. Tobey ◽  
Roger F. Wheelis ◽  
C. Thomas Yarington
Keyword(s):  
Electron Microscopy ◽  
Light Microscopy ◽  
Accurate Determination ◽  
Final Diagnosis ◽  
Primary Lesion ◽  
Low Grade ◽  
Pathologic Evaluation ◽  
First Case ◽  
Per Se

Electron microscopy (EM) was useful in establishing the final diagnosis in specific instances of liposarcoma and fibrosarcoma of the larynx. In the first case light microscopy revealed cells that met the histologic criteria of a low grade liposarcoma; EM revealed cells that displayed a varied ultrastructural differentiation; thus the tumor was classified as a mixed mesenchymal tumor rather than liposarcoma per se. In the second case, pathologic evaluation indicated a grade 2 fibrosarcoma. EM revealed malignant mesenchymal cells that closely recapitulated normal fibroblasts (no epithelial differentiation was present). This kind of information enables more accurate determination of the source of the primary lesion than results of light microscopy alone.

Re-evaluation of merogony of a Cystoisospora ohioensis-like coccidian and its distinction from gametogony in the intestine of a naturally infected dog

Parasitology ◽  
2019 ◽  
Vol 146 (6) ◽  
pp. 740-745
Author(s):  
J. P. Dubey
Keyword(s):  
Electron Microscopy ◽  
Transmission Electron Microscopy ◽  
Light Microscopy ◽  
Developmental Stages ◽  
Surface Epithelium ◽  
Ultrastructural Studies ◽  
Transmission Electron ◽  
Sexual Stages ◽  
Endogenous Stages ◽  
Study Development

AbstractFour species of Cystoisospora, C. canis, C. ohioensis, C. neorivolta and C. burrowsi are described from feces of dogs. Of these, the oocysts of C. canis are the largest and easily distinguished from the remaining three species. Oocysts of C. ohioensis, C. neorivolta and C. burrowsi are difficult to distinguish because of overlap in their sizes. However, based on endogenous developmental stages, C. ohioensis is distinct from C. neorivolta and C. burrowsi because its endogenous stages are confined to surface epithelium of intestine whereas endogenous stages of C. neorivolta and C. burrowsi are predominantly in the lamina propria. There are uncertainties regarding the endogenous stages of C. neorivolta and C. burrowsi and there is no way now to determine whether C. burrowsi and C. neorivolta are different parasites; therefore, these are referred as C. ohioensis-like organisms. Additionally, mode of division of asexual stages of coccidia of dogs is largely unknown and ultrastructural studies are lacking. In the present study, development of asexual and sexual stages of a C. ohioensis-like organism in a naturally infected dog is described by light microscopy and by transmission electron microscopy. Merozoites divided by endodyogeny/merogony. Meronts were crescent/merozoite-shaped and contained a maximum of eight nuclei. A distinctive feature of merozoites was the presence of many PAS-positive amylopectin granules that were absent or rare in immature microgamonts making it possible to distinguish them.

scholarly journals Ultrastructural Studies in Acute Promyelocytic Leukemia

Blood ◽  
1972 ◽  
Vol 39 (5) ◽  
pp. 628-636 ◽  
Author(s):  
Henry K. Tan ◽  
Bettye Wages ◽  
Harvey R. Gralnick
Keyword(s):  
Electron Microscopy ◽  
Bone Marrow ◽  
Light Microscopy ◽  
Acute Promyelocytic Leukemia ◽  
Disseminated Intravascular Coagulation ◽  
Light And Electron Microscopy ◽  
Promyelocytic Leukemia ◽  
Uniform Size ◽  
Ultrastructural Studies ◽  
Large Numbers

Abstract In this investigation, the cells of eight patients with acute promyelocytic leukemia were followed by light and electron microscopy. Promyelocytes from untreated patients were filled with large, splinter-shaped granules. The granules were lysosomes, with some showing the ultrastructural features of Auer bodies. In cases responsive to chemotherapy, promyelocytes contained only infrequently splinter-shaped lysosomes, while most lysosomes were of more uniform size and shape. The persistence of large numbers of splinter-shaped lysosomes within promyelocytes was associated with episodes of disseminated intravascular coagulation less responsive to heparin treatment. Promyelocytes from patients in remission were similar to promyeloctyes from nonleukemic bone marrow. The ultrastructural differences in lysosome morphology provide a better criterion for distinguishing malignant from normal promyelocytes than previously detectable by light microscopy alone.

scholarly journals Direct Immunofluorescence of Renal Biopsy: Perspective of an Immunopathologist

2015 ◽  
Vol 49 (1) ◽  
pp. 10-17
Author(s):  
Kusum Joshi ◽  
Vinay Sakhuja ◽  
Ranjana Walker Minz ◽  
Seema Chhabra ◽  
N Khirwadkar ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Renal Biopsy ◽  
Membranoproliferative Glomerulonephritis ◽  
Immunofluorescence Microscopy ◽  
False Negative ◽  
Final Diagnosis ◽  
Renal Diseases ◽  
Direct Immunofluorescence ◽  
Renal Biopsies ◽  
Membranous Glomerulopathy

ABSTRACT Aims This study was undertaken to analyze the strength of direct immunofluorescence microscopy in the diagnoses of renal diseases vis-á-vis histopathology. An attempt was also made to present advantages and pitfalls of this age old technique. Settings and design A total of 250 consecutive renal biopsies received over a period of 1 year were analyzed. The histopatholgy and direct immunofluorescence slides were reported by two separate pathologists and later compared to reach a final diagnosis. Results Two cores examined by histopatholgy and direct immunofluorescence microscopy yielded a final diagnosis in 98% cases. In 2% of renal biopsies (4 biopsies with a ‘descriptive’ label and 1 case of amyloid like nephropathy), additional diagnostic aids like electron microscopy were required to clinch a conclusive diagnosis. No case of anti-glomerular basement membrane glomerulonephritis or hereditary glomerular disease was observed over 1 year period under review. Conclusion Direct immunofluorescence helped to detect IgA nephropathy (5% cases), it incresed the sensitivity of detection of focal segmental glomeulosclerosis (23 more cases) and membranous glomerulopathy (2 more cases). It helped in detection as well as grading of glomerulonephritis in lupus nephritis. Crescentic glomerulonephritis could be further categorized into immune complex and pauci-immune subtypes. Immunofluorescent dye thioflavin T proved out to be a very sensitive dye for detection of amyloidosis. Membranoproliferative glomerulonephritis/ diffuse proliferative glomerulonephritis cases were less well discriminated by direct immunofluorescence than histopathology. Two percent of renal biopsies (2 cases of membranoproliferative glomerulonephritis, 1 case of membranous glomerulopathy, 1 case of mesangioproliferative glomerulonephritis) were false negative on direct immunofluorescence implying technical errors. Thus, correct diagnosis of glomerulonephritis requires direct immunofluorescence microscopy in parallel with light microscopic examination and also correlation with clinical features, serological as well as biochemical parameters. In less than 2% of patients, electron microscopy might be essential. How to cite this article Minz RW, Chhabra S, Joshi K, Khirwadkar N, Sakhuja V, Pasricha N, Bhardwaj R. Direct Immunofluorescence of Renal Biopsy: Perspective of an Immunopathologist. J Postgrad Med Edu Res 2015;49(1):10-17.

Revisions in the technique of epi-illumination light microscopy for the study of floral and vegetative apices

1980 ◽  
Vol 58 (23) ◽  
pp. 2491-2495 ◽  
Author(s):  
U. Posluszny ◽  
M. G. Scott ◽  
R. Sattler
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Light Microscopy ◽  
Serial Sectioning ◽  
Scanning Electron ◽  
Made In

Many improvements have been made in the technique of epi-illumination light microscopy. These modifications have resulted in micrographs of better resolution and subsequently in greater flexibility in the study of floral and vegetative apices. The preparation, mounting, microscopy, and photography of apices are discussed in detail. The correlation of this technique with others such as scanning electron microscopy and serial sectioning is discussed. The numerous applications of epi-illumination light microscopy are considered.

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