Analysis of glucocorticoid receptor and microRNAs expression in pathological renal tissues.

Glucocorticoid receptor (GR) is expressed in normal renal podocytes; however, its expression differs among renal diseases. The expression of GR as well as its epigenetic regulators microRNA (miR)30a, miR24 and miR370 was studied in the renal tissues of patients with systemic lupus nephritis (LN), minimal changes disease (MCD) and pauci-immune glumeronephritis (PIN). A total of 51 patients undergoing renal biopsy and 22 nephrectomised controls with no history of parenchymal renal disease were recruited from the Clinic of Nephrology and Renal Transplantation of General Laikon hospital between November 2016 and March 2019. All patients were newly-diagnosed and they were naïve of any treatment. The mRNA and protein expression were analyzed through reverse transcription-quantitative PCR and immunohistochemistry respectively. Written consent was obtained from all participants. GR mRNA expression was significantly reduced in all pathological samples compared with the 'normal' renal tissues used as controls (P=0.023 for LN, P=0.05 for MCD and P=0.004 for PIN). Similarly, GR protein expression was lower in all pathological samples (>6 GR positive podocytes/glomerulus in 50% of patients with LN and MCD and 18% with PIN) compared with controls (>6 positive podocytes/glomerulus in all the controls). PIN samples presented significantly lower GR mRNA and protein expression compared with LN and MCD samples. No significant differences were observed in the miR30a expression when comparing pathological with 'normal' renal samples. miR24 and miR370 expression demonstrated statistically significant difference in all pathological compared with 'normal' tissues. Moreover, GR expression was not significantly associated with either LN disease activity score or the response to the treatment. GR and miR24 expression was significantly reduced whereas miR370 significantly increased in all pathological compared with 'normal' renal tissues implying their protentional role in nephritis pathogenesis and treatment. Analysis of larger samples are required for more robust statistical analysis.

A surgical approach to squamous cell carcinoma of penis that also resolved the psychological dysfunction of the patient.

In this case study, we present an unusual case with squamous cell carcinoma surrounding the penis involving foreskin and glans of penis. In addition, multiple satellite nodules were noted in the pubis. A 57-year-old circumcised heterosexual male patient presented with a penile lesion existing for 10 years. At the same time, he was referred to an outpatient memory clinic because of persistent subjective memory complaints associated with depression and anxiety. The patient was operated under general anaesthesia. The lesion was resected circumferentially with macroscopic clearance, resulting in complete degloving of the penile shaft. Neurovascular bundles were preserved. Histopathological analysis of the lesion revealed an invasive and poorly differentiated squamous cell carcinoma, and the surgical margins were free from tumour. The patient was followed for 18 months. He did not have voiding difficulty. Pelvic tomographic and physical examination findings did not reveal any episode of recurrence or metastasis. Treatment of carcinoma resulted in a simultaneous full recovery of his memory decline and he remained free of depression and anxiety symptoms over time.

Anticoagulant-related nephropathy: a case report and review of the literature of an increasingly recognized entity.

Treatment with oral anticoagulants has been associated with worsening kidney function in patients with chronic kidney disease (CKD) as well as among patients without underlying CKD. Thus, anticoagulant-related nephropathy (ARN) is an increasingly recognized entity nowadays, mainly associated with warfarin anticoagulation. Recent evidence indicates that patients treated with the direct anticoagulants may also be at risk of ARN. However, the true incidence of anticoagulant-related nephropathy is difficult to determine. The typical histological lesion involves renal tubular occlusion by red blood cells (RBCs), tubular red blood cell casts on light microscopy and dysmorphic RBCs in the glomerulus on electron microscopy. In the absence of active glomerulonephritis or other inflammatory changes that could account for glomerular hemorrhage, the above findings confirm the diagnosis. Dabigatran etexilate was the first direct oral anticoagulant approved for stroke prevention in patients with non-valvular atrial fibrillation. In this article, we describe a rare case of dabigatran etexilate-induced nephropathy in a patient with preexisting IgA nephropathy and review the recent literature regarding this increasingly recognized entity.

"Diabetic nephropathy" in a non-diabetic patient.

Kimmelstiel and Wilson originally described nodular glomerulosclerosis as the pathognomonic lesion of diabetic nephropathy. Nevertheless, nodular glomerulosclerosis pattern can rarely occur in non-diabetic patients. In such cases, the differential diagnosis includes membranoproliferative glomerulonephritis, light or heavy chain deposition disease, amyloidosis, fibrillary and immunotactoid glomerulonephritis and chronic hypoxic or ischemic conditions. In cases that the above entities cannot be proven, the term idiopathic nodular glomerulosclerosis is given. Here, we report a case of a male patient with renal failure stage IV and non-nephrotic range proteinuria. He had a history of heavy smoking and hypertension. The kidney biopsy revealed diabetic-like lesions. However, there was no evidence of glucose impairment despite the thorough work-up at the biopsy time and thereafter. The laboratory data and the electron microscopy of the specimen could not prove any other cause of nodular glomerulosclerosis, and the final diagnosis was idiopathic nodular glomerulosclerosis. Moreover, we focus on the pathological differential diagnosis and work-up.

Crescentic glomerulonephritis and membranous nephropathy: a rare coexistence.

BACKGROUND: The coexistence of crescents and membranous glomerulonephritis (MGN) is a special characteristic in lupus nephritis. In the absence of the characteristic histological features of lupus nephritis, MGN with crescents should raise the possibility of two other histopathological entities: anti-GBM disease and necrotizing and crescentic glomerulonephritis. The last one includes patients with positive ANCA serology or not. RESULTS AND CONCLUSIONS: Here, we describe a case of a male patient who presented with extrarenal vasculitis symptoms, acute renal failure, hematuria and nephrotic-range proteinuria. ANCA serology was positive, and the biopsy revealed crescentic vasculitis plus membranous nephropathy. Reviewing the whole literature about similar histological cases, we included 38 cases with ANCA-positive serology and 30 ones with no ANCA in serum. It seems that in the first category vasculitis symptoms predominate, while in the second one these symptoms are absent. Their histological features have no major differences. In any case, the clinical course of these patients is serious, and in most cases, immunosuppression is essential in order to avoid end-stage renal disease.

An unusual case of acute kidney injury - idiopathic granulomatous tubulointerstitial nephritis.

We present a case which emphasizes the importance of performing a kidney biopsy in each case of acute kidney injury (AKI) of unknown etiology. The unexpected histological diagnosis of granulomatous interstitial nephritis (GIN) is a rare cause of AKI. The main causes of GIN include drugs (NSAIDs, antibiotics), sarcoidosis, and infections (mycobacterial and fungal). In our case, a 68-year-old woman was admitted with AKI, absence of symptoms and unremarkable history, apart from coronary heart disease. Renal biopsy was performed, since history as well as clinical and laboratory data could not define a cause of AKI. A more meticulous clinical and laboratory investigation followed the histological diagnosis in order to rule out sarcoidosis, vasculitis or any other known causes of GIN. Finally the diagnosis was characterized as AKI due to idiopathic GIN. The patient responded well to corticosteroids.

A solitary fibrous tumor of the kidney in a 26-year-old man.

BACKGROUND: Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that typically arise in the pleura. There are several reports of cases that arose from a variety of sites. SFT of the kidney is rare and, to our knowledge, only 25 cases have been published in the literature to date. SFTs in the kidney have similar morphologic and immunologic features and biologic behaviors as SFTs found elsewhere. In general, patients with SFTs of the kidney have a favorable prognosis. CASE: We report a case of SFT of the right kidney in a 26-year-old man. The tumor was localized in the upper and mid pole of the kidney. A nephrectomy was performed. The tumor was a well-circumscribed, solid mass attached to the renal capsule without necrosis or hemorrhage. Microscopically, a spindle cell neoplasm with alternating hypo- and hypercellular areas, storiform, fascilular and hemangiopericytoma-like growth pattern and less cellular dense collagen deposition was observed. Some glomeruli and renal tubules were entrapped by the tumor cells. There were no mitotic figures. Immunohistochemically, the tumor cells were consistently positive for CD34, CD99, and bcl-2. There was no evidence of recurrence after 6 months of follow-up. DISCUSSION: Although morphology is most important in formulating the initial differential diagnosis, the addition of immunohistochemistry is vital in arriving at the correct classification of renal spindle cell tumors.