Nephrology Education
A case of parathyroid adenoma adjacent to the thoracic spine in a hemodialysis patient
Kentaro Nakai, Hideki Fujii, Koichiro Maeno, Kotaro Nishida, Akira Kobayashi, Jeongsoo Shin, Shigeo Hara and Shinichi Nishi
Price
42.00 $
Volume 81 (2014) p. 52 - 57
Abstract
Clinical Nephrology, Vol. 81 – No. 1/2014 (52-57)
A case of parathyroid adenoma adjacent to the thoracic spine in a hemodialysis patient
Kentaro Nakai1, Hideki Fujii1, Koichiro Maeno2, Kotaro Nishida2, Akira Kobayashi3, Jeongsoo Shin4, Shigeo Hara5, and Shinichi Nishi1
1Division of Nephrology and Kidney Center, 2Department of Orthopedic Surgery, Kobe University School of Medicine, 3Kobayashi Clinic, 4Gojin-kai Motomachi HD Clinic, and 5Department of Pathology, Kobe University School of Medicine, Kobe, Japan
Ectopic parathyroid glands are detected occasionally, especially in cases of recurrent hyperparathyroidism after initial parathyroidectomy. Their ectopic locations usually result from faulty migration during embryogenesis. Ectopic parathyroid glands can be found within the thyroid gland, thymus, mediastinum, carotid sheath, or retropharynx, which lie along the path of their normal migration. Here we report a rare case of parathyroid adenoma adjacent to the thoracic spine in a hemodialysis patient who had undergone parathyroidectomy previously. A 67-year-old woman on maintenance hemodialysis since 1993 developed hyperparathyroidism. She underwent total parathyroidectomy with autotransplantation in 2007. Histological examination of the parathyroid glands showed hyperplasia in three glands and adenoma in one. Serum parathyroid hormone levels gradually increased after a year. Ultrasonography of the neck and upper limbs was negative, but technetium-99-sestamibi scanning showed focal uptake in the posterior mediastinum. Computed tomography and magnetic resonance imaging confirmed a tumor adjacent to the left costovertebral junction of the third thoracic vertebra. A tumor resection was performed in 2010, and histopathological examination showed a parathyroid adenoma. Parathyroid adenoma adjacent to the thoracic spine has not been reported previously, and our case suggests that technetium-9-sestamibi scanning is useful for the correct preoperative diagnosis of such rare cases of ectopic parathyroid glands.Correspondence to:
Kentaro Nakai, MD
Division of Nephrology and Kidney Center
Kobe University School of Medicine
7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
Email: [email protected]
Nephrology Education
Idiopathic immune complex-mediated tubulointerstitial nephritis with hypocomplementemia and neutrophil-rich interstitial infiltrates
Haruka Ikuta, Jaegi Shim, Masahiro Takahashi, Mitsuteru Koizumi, Koichi Seta, Shigeo Hara, and Kensei Yahata
Price
42.00 $
Volume 90 (2018) p. 357 - 362
Abstract
Clinical Nephrology, Vol. 90 – No. 5/2018 (357-362)
Idiopathic immune complex-mediated tubulointerstitial nephritis with hypocomplementemia and neutrophil-rich interstitial infiltrates
Haruka Ikuta1, Jaegi Shim1, Masahiro Takahashi1, Mitsuteru Koizumi1, Koichi Seta1, Shigeo Hara2, and Kensei Yahata1
1Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, and 2Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Hyogo, Japan
A 69-year-old man presented with acute kidney injury, hypocomplementemia, antinuclear antibody, and anti-dsDNA antibody. He had no signs of systemic lupus erythematosus or Sjögren syndrome. He had not begun taking any new drugs in the preceding 6 months. Kidney biopsy revealed 13 glomeruli, 3 with global sclerosis. The remaining glomeruli showed slight mesangial proliferation. The interstitial inflammation was extensive, comprising mainly mature lymphocytes and plasma cells, neutrophils, and a few eosinophils. Remarkable granular and diffuse deposition of IgG and C1q was observed along the tubular basement membranes. Electron microscopy showed electron-dense deposits in the tubular basement membrane. Immunohistochemistry showed only 1 – 4 IgG4-positive plasma cells per high-power field and an IgG4/CD138 ratio of ~ 10%. He was treated with oral prednisolone 35 mg/day, and his kidney function gradually improved. This is a unique case that is not consistent with any known disease entities with immune complex-mediated tubulointerstitial nephritis.
Correspondence to:
Kensei Yahata, MD
Department of Nephrology
National Hospital Organization Kyoto Medical Center
1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan
Email: kenseiyahata@
yahoo.co.jp
Nephrology Education
A case of membranous nephropathy characterized by atypical distribution of phospholipase A2 receptor
Toshiki Hyodo, Kei Saito, Keiji Kono, Shinichi Nishi, Tomoo Itoh, and Shigeo Hara
Price
42.00 $
Volume 91 (2019) p. 114 - 119
Abstract
Clinical Nephrology, Vol. 91 – No. 2/2019 (114-119)
A case of membranous nephropathy characterized by atypical distribution of phospholipase A2 receptor
Toshiki Hyodo1#2, Kei Saito3, Keiji Kono3, Shinichi Nishi3, Tomoo Itoh2, and Shigeo Hara2#4
1Department of Diagnostic Pathology, Kakogawa Medical Center, Kakogawa, 2Department of Diagnostic Pathology, 3Department of Nephrology, Kobe University Graduate School of Medicine, and 4Department of Diagnostic Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
A 77-year-old man was referred to our hospital with persistent proteinuria and progressive lower leg edema. Past history was unremarkable except for hypertension. Autoimmune diseases, infections, and malignancies were excluded based on clinical and laboratory test results. Renal biopsy specimens showed membranous nephropathy with segmental distribution of spikes and bubbling appearance. Double contour formation in glomerular tufts was also observed. There were no proliferative changes in the glomeruli. Interstitial fibrosis and tubular atrophy were moderate, and no interstitial inflammation was observed. Arteries showed moderate sclerotic changes with hyalinosis. Immunohistochemical analysis revealed no thrombospondin type 1 domain-containing 7A reactivity. Immunofluorescence staining showed segmental granular positivity of IgG on glomerular tufts and focal staining of IgG on the tubular basement membranes. IgG deposits (subclass distribution: IgG1, 2+; IgG2, –; IgG3, 1+; IgG4, 2+) and phospholipase A2 receptor type 1 (PLA2R1) immunoreactivity showed similar distributions in both glomeruli and renal tubular basement membranes. Electron microscopy revealed subendothelial edema in partially collapsed glomerulus. No subepithelial dense deposits were observed in the glomeruli under an electron microscope. This is the first documented case of membranous nephropathy (MN) with segmental distribution of PLA2R1 in the glomeruli and focal PLA2R1 positivity in renal tubular basement membranes. Our findings extend the pathological presentation of PLA2R1-associated MN. Future studies are required to examine the mechanistic insights of these atypical histopathological features.
Correspondence to:
Shigeo Hara, MD, PhD
Department of Diagnostic Pathology
Kobe City Medical Center General Hospital
2-1-1, Minatojima Mimamimachi, Chuo-ku,
Kobe 650-0017, Japan
Email: [email protected]
case studies
A case of nephrotic syndrome showing contemporary presence of apolipoprotein E2 homozygote glomerulopathy and membranous nephropathy-like findings modified by apolipoprotein E Toyonaka
Hisako Hirashima, Toshiyuki Komiya, Naoya Toriu, Shigeo Hara, Akira Matsunaga, Takao Saito, and Eri Muso
Volume 6 (2018) p. 45 - 51
Abstract
Clinical Nephrology – Case Studies, Vol. 6/2018 (45-51)
A case of nephrotic syndrome showing contemporary presence of apolipoprotein E2 homozygote glomerulopathy and membranous nephropathy-like findings modified by apolipoprotein E Toyonaka
Hisako Hirashima1, Toshiyuki Komiya1,2, Naoya Toriu1, Shigeo Hara3, Akira Matsunaga4, Takao Saito5, and Eri Muso1,6,7
1Division of Nephrology, Kansai Electric Power Hospital, 2Kansai Electric Power Medical Research Insitute, Osaka, 3Department of Pathology, Kobe University School of Medicine, Hyogo, 4Department of Laboratory Medicine, Faculty of Medicine, Fukuoka University, 5Sanko Clinic, Fukuoka, Japan, 6Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Insitute, Osaka, and 7Department of Pathological Diagnosis, Kyoto University Hospital, Kyoto, Japan
A 79-year-old man was admitted to our hospital for proteinuria due to nephrotic syndrome. Renal biopsy revealed focal sclerosis and foam cell infiltration in the glomerulus. In addition, electron microscopic findings (EM) revealed peculiar electrondense deposits (EDDs) in both sides of the glomerular basement membrane. Although subepithelial deposits had spike formation highly resembling those seen in membranous nephropathy (MN), immunoglobulins and complements were not identified by immunofluorescence study, and microbubbles appeared in high magnification of EM different from the immune disease. The analysis of apolipoprotein (Apo) E showed an elevated concentration of plasma ApoE. The phenotype, genotype, and DNA sequence studies revealed homozygous ApoE2/2 and a novel missense mutation called ApoE Toyonaka (Ser197Cys). This case may confirm the independent responsibility of ApoE2/2 and ApoE Toyonaka for ApoE2 homozygote glomerulopathy and MN-like EDD findings, respectively.Correspondence to:
Hisako Hirashima, MD, Division of Nephrology, Kansai Electric Power Hospital, 2-1-7 Fukushima, Fukushima-ku, Osaka-shi, Osaka-fu 553-0003, Japan
Email: [email protected]
