Role of Systemic Inflammatory Markers in Pediatric Kidney Transplantation.

BACKGROUND: Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII = N × P/L), and neutrophil percentage-albumin ratio (NPAR) have become accepted markers of inflammation in recent years. These indices are used as indicators of disease activity, mortality, and morbidity in many diseases. This study evaluated the relationship between inflammatory indices and graft function in pediatric kidney transplant recipients. METHODS: Medical records of pediatric patients who underwent kidney transplantation at Ege University between 1995 and 2020 were reviewed retrospectively. Demographic, clinical, and laboratory data were recorded during the third month, first year, and fifth year of transplantation and at the last visit. RESULTS: The median age of the 119 patients (60 boys/59 girls) at the time of transplantation was 154 months, and the median follow-up period was 101 months. According to Spearman correlation analysis, patients' final creatinine levels were positively correlated with NLR (r = 0.319), PLR (r = 0.219), SII (r = 0.214), and NPAR (r = 0.347) of the last visit; final estimate glomerular filtration rate levels were negatively correlated with NLR (P = .010, r = -0.250) and NPAR (P = .004, r = -0.277). The median NPAR of the patients with chronic allograft dysfunction at the last visit was found to be statistically significantly higher than without (P = .032). CONCLUSION: NLR, PLR, SII, and NPAR values are correlated with creatinine levels after 5 years of kidney transplantation. The NPAR and final creatinine levels had the highest correlation coefficient among these inflammatory markers. These results suggest that inflammatory markers, especially NPAR, may be a candidate to be an indicator of ongoing inflammation in the graft.

Multiparametric Prostate Magnetic Resonance Imaging Before Radical Prostatectomy: Can it Predict Histopathology?

PURPOSE: We aimed to investigate the histopathological correlation of the suspected prostate malignancy detected in multiparametric prostate magnetic resonance imaging (mpMRI). MATERIALS AND METHODS: The data of 93 patients underwent radical prostatectomy and had preoperative mpMRI were examined. Age and pre-operative Prostate-Specific Antigen value were retrospectively collected from patient files. The pathology specimens were examined again and post-operative ISUP grade group, other pathological findings (seminal vesicle invasion, lymph node involvement and extraprostatic extension), pre-operative mpMRI were re-examined and PIRADS score, extracapsular extension, seminal vesicle invasion, neurovascular bundle invasion, lymph node involvement and ADC values were recorded. RESULTS: 151 (92,07%) of 164 lesions detected in mpMRI were histopathologically correlated. 80% of patients with seminal vesicle invasion (P < 0.001), 28.8% of patients with extracapsular extension (P < 0.052) and 42.9% of patients with lymph node involvement (P = .001) in mpMRI were histopathologically correlated. A significant relationship was found between PIRADS scores and ISUP grade groups (P < 0.001). There was a negative correlation between ADC values and ISUP grade groups (P < 0.001). CONCLUSION: Our study showed that the lesions detected by mpMRI showed a high histopathological correlation.

A histopathological scoring and grading system to predict outcome for patients with AA amyloidosis.

PURPOSE: Renal involvement is associated with significant morbidity and mortality in AA amyloidosis. Extend of amyloid deposition in kidney biopsies may be predictive for clinical manifestations and outcomes. The aim of our study is to assess clinical features of patients with biopsy-proven renal AA amyloidosis and to evaluate the relationship between histopathological scoring and grading of renal amyloid deposition with clinical findings and outcomes. METHODS: The study included 86 patients who were diagnosed with renal AA amyloidosis. The demographic and clinical features at the time of biopsy and follow-up data were retrospectively collected. Amyloid deposition in glomeruli, interstitium, vessels and tubulointerstitial findings were scored and renal amyloid prognostic score (RAPS) was assigned by adding all scores. RAPS was further divided into three grades (RAPS grade I, II, III). RESULTS: Median age was 50 (36-59) years. Familial Mediterranean fever was the leading cause. RAPS grade and interstitial inflammatory infiltration were associated with baseline eGFR and glomerular amyloid deposition was associated with proteinuria. During the follow-up period (median 50 months), 39 patients developed ESRD. Extensive (involving > 50%) glomerular amyloid deposition, baseline eGFR and proteinuria were independent risk factors for progression to end stage renal disease. Death censored renal survival was significantly lower among patients with RAPS grade III compared to those with RAPS grade I and II. Patient survival rate was not different according to RAPS grade. CONCLUSIONS: Degree of renal amyloid accumulation is associated with renal function and outcome. The scoring and grading system may be predictive in clinical outcome and contribute to understanding of disease mechanism.

Testicular Adrenal Rest Tumor (TART) in congenital adrenal hyperplasia.

Congenital adrenal hyperplasia is one of the most common autosomal recessive genetic disorders. Testicular adrenal tumors are significant complications of congenital adrenal hyperplasia. We would like to present two patients of testicular adrenal rest tumors. Patient 1 24 year-old male, he was diagnosed with congenital adrenal hyperplasia at the age of 8 due to precocious puberty. He received hydro-cortisone treatment until the age of 18. Testicular mass had been detected and right radical orchiectomy had been applied 6 months ago and reported as testicular adrenal rest tumor. In scrotal ultrasound, a mixed type mass lesion (6 × 4x3 cm) covering a large part of left testis was observed. The imaging findings were consistent with adrenal rest tumor. The patient took adrenocorticotropic hormone supressive therapy with dexamethasone 0.75 mg once a day. Patient 2, 38 year-old male, he had been followed-up as adrenal insufficiency for 35 years. He underwent right orchiectomy operation due to the testicular mass in 2010 and the pathological examination revealed Leydig cell tumor. In scrotal ultrasound, small multifocal lesions were detected on the left testis and resection was done. It was reported as testicular adrenal rest tumor. He is being followed-up with glucocorticoid treatment according to androgen and adrenocorticotropic hormone levels. Early diagnosis of testicular adrenal rest tumor is significant in preventing irreversible testicular damage and infertility. In the differential diagnosis, we should keep in mind that testicular adrenal rest tumor can mimic other testicular tumors such as primary germ cell tumors.

Acinar Adenocarcinoma of Prostate with Predominant Ttf-1 Positive Intraductal Component.

Intraductal carcinoma of prostate has been previously described in radical prostatectomies. It's rarely encountered in needle biopsies in the absence of infiltrative carcinoma. But, both histogenesis and nomenclature of the lesion is still controversial. Among the pure intraductal carcinoma of prostate cases, a different solid patern was described with smaller nuclei at the center of the ducts. However, there is a lack of information about the association of those cases with acinar prostate adenocarcinoma. Herein, we describe a case of acinar adenocarcinoma with predominant non-neuroendocrine TTF-1 positive small cell intraductal component.

Intratubular large cell hyalinizing Sertoli cell tumor of the testis presenting with prepubertal gynecomastia: a case report.

Intratubular large cell hyalinizing Sertoli cell neoplasia (ITLCHSCN) resulting from Sertoli cells of the testis are mainly reported in young adults and these are rarely seen in childhood. The most common presenting symptoms of the patients diagnosed with ITLCHSCN are gynecomastia, enlargement in the testicles, increase in growth velocity, and advanced bone age. Symptoms are basically resulting from increased aromatase enzyme activity in Sertoli cells. In this case report, an eight-and-a-half-year-old case presenting with complaint of bilateral gynecomastia since two years, showing no endocrine abnormality in laboratory during two years of follow-up, determined to have progression in bilateral gynecomastia, increase in testicular volumes, advanced bone age, increase in growth velocity in the clinical follow-up, and diagnosed with ITLCHSCN after testis biopsy was presented.

The effect of hypercalcemia on allograft calcification after kidney transplantation.

PURPOSE: Persistent hypercalcemia after kidney transplantation (KTx) may cause nephrocalcinosis and graft dysfunction. The aim of this study was to evaluate patients with hypercalcemia and assess its effect on tubulointerstitial calcification. METHODS: A total of 247 recipients were enrolled. Transient and persistent hypercalcemia was defined as hypercalcemia (corrected serum calcium >10.2 mg/dL) persisting for 6 and 12 months after KTx, respectively. The severity of calcification in the 0-h, 6- and 12-month protocol biopsies of patients with transient (n = 8) and persistent hypercalcemia (n = 20) was compared with a matched control group (n = 28). RESULTS: Twenty-eight patients were hypercalcemic at 6 months posttransplantation. Serum calcium levels were normalized in eight of them at the end of the first year. Dialysis duration was a positive predictor of persistent hypercalcemia. Tubulointerstitial calcification was detected in 70.6 and 90 % of patients with persistent hypercalcemia at 6 and 12 months posttransplantation, respectively. In 20 % of patients with transient hypercalcemia, severity of calcification regressed at 12 months posttransplantation along with normalization of serum calcium levels. Graft functions and histopathological findings (ci, ct, ci + ct, cv, ah, percentage of sclerotic glomeruli) were not different at 6 and 12 months posttransplantation. CONCLUSIONS: Hypercalcemia and persistent hyperparathyroidism are not rare after KTx. Tubulointerstitial calcification is more common and progressive among patients with persistent hypercalcemia. Normalization of calcium levels may contribute to regression of calcification in some patients.

P21 and p27 Immunoexpression in Upper Urinary Tract Urothelial Carcinomas.

p21 and p27 are members of cyclin-dependent kinase family, which function as tumor suppressors and they are involved in development and progression of several malignancies. We investigated their expression in upper urinary tract urothelial carcinoma (UUTUC). Radical nephroureterectomy materials of 34 patients were assessed by immunohistochemistry to evaluate expression of p21 and p27 in UUTUC. Results were correlated with various clinicopathological variables as age, gender, tumor grade and stage, tumor architecture, multifocality, subsequent bladder carcinoma development and clinical outcome.p21 and p27 expression was observed in 52.9 % (n = 18) and 88.2 % (n = 30), respectively. A total of 21 tumors (61.7 %) showed either total loss of p21 expression (n = 16, 47 %) or lower expression (n = 5, 14.7 %). No correlation was found between p21 expression and clinicopathologic variables. Cases showing total loss or lower p27 expression (11.7 % and <25.6 %, respectively) (n = 19, 55.8 %) constituted 67.6 % (n = 23) of the cases totally. This loss or lower p27 expression correlated with a shorter overall survival in both univariate and multivariate analysis (p = 0.039 and p = 0.037, respectively). None of the noninvasive tumors (papillary and nodular tumors) showed loss of p27 (p = 0.016) while 33.3 % of invasive ones showed p27 loss. Noninvasive tumor architecture also correlated with subsequent bladder carcinoma development (p = 0.032) while invasive tumor architecture correlated with advanced stage (T3 and T4) (p = 0.003). p27 is widely expressed in UUTUC, while p21 expression is observed in half of the cases. Loss of p27 expression correlated with tumor architecture and overall survival in UUTUC. However, further research is needed to assess their role in UUTUC.

Recurrent lupus nephritis after transplantation: Clinicopathological evaluation with protocol biopsies.

AIM: Lupus nephritis (LN) is an important complication of systemic lupus erythematosus (SLE). The aim is to use indication and protocol biopsies to determine clinicopathological findings and outcomes of patients with LN undergoing kidney transplantation (KTx). METHODS: Patients who underwent KTx due to LN were retrospectively analyzed. Recurrent LN (RLN) was diagnosed by transplant kidney biopsy. RESULTS: Among 955 KTx patients, 12 patients with LN as the cause of end-stage renal disease were enrolled. Five patients were male. Mean follow-up time was 63 ± 34 months. At the last follow-up visit, mean levels of serum creatinine and proteinuria were 137.0 ± 69.0 µmol/L and 0.26 ± 0.26 g/day, respectively. Eighteen indication and 22 protocol biopsies were performed; 27 biopsies were additionally evaluated by immunofluorescence. In two recipients, subclinical RLN was confirmed by protocol biopsies. Clinical recurrence occurred in four patients. Among patients with RLN, time from diagnosis of LN to KTx was significantly shorter and use of ATG as induction treatment was significantly lower. Graft loss occurred in two recipients who had clinical RLN. Five-year overall graft survival was 85.7%. CONCLUSION: Kidney transplantation is a reasonable option for patients with ESRD secondary to SLE. However, recurrence of LN is common if protocol biopsies are included in post-transplantation surveillance.

The relationship between renal volume and histology in obese and nonobese kidney donors.

BACKGROUND: Obesity and related kidney diseases have become a global epidemic problem. However, the underlying pathogenesis of obesity-related renal diseases has not been clearly understood. In this study, we explored the link between renal volume (RV) determined by computed tomography (CT) and renal histology together with functional parameters in an obese population. MATERIALS AND METHODS: Eighty-two kidney donors who underwent CT for the measurement of kidney volume and zero-hour renal biopsy for renal histology were included in this cross-sectional study. Protein creatinine clearance and eGFR were evaluated in 24-h urine specimens as indicators of renal function. RESULTS: Mean body mass index (BMI) was 28 ± 4.2 kg/m(2); 32.9% (n = 27) were obese. Mean RV was 196 ± 36 cm(3). RV was positively correlated with BMI, body surface area and creatinine clearance and negatively with HDL-cholesterol in the whole population. Renal function parameters of obese subjects were better, and their renal volumes were higher compared with the nonobese subjects. In obese subjects, corrected RV was positively correlated with glomerular filtration rate (r = 0.46, P = 0.01) and negatively with sclerotic glomeruli (r = -0.38, P = 0.04) and chronicity index (r = -0.43, P = 0.02). In adjusted ordinal logistic regression analysis, corrected RV was significantly associated with chronicity index (OR: 0.96; P = 0.01). CONCLUSIONS: In obese cases, decreased RV determined by CT is associated with worse renal histology. In this population, kidney imaging techniques may provide important clues about renal survival.

Digitally reinforced hematoxylin-eosin polarization technique in diagnosis of rectal amyloidosis.

AIM: To investigate the efficacy of the digitally reinforced hematoxylin-eosin polarization (DRHEP) technique for detection of amyloidosis in rectal biopsies. METHODS: One hundred hematoxylin-eosin (HE) stained rectal biopsies with Congo-red (CR)-positive amyloid depositions and 50 control cases with CR-negative amyloid-mimicking areas were scanned blinded to the CR results for amyloid depositions under both bright and polarized light, and digitally photographed using the DRHEP technique, to accentuate the faint birefringence observed in HE slides under polarization. The results of DRHEP and HE evaluation were statistically correlated with CR polarization results with respect to presence and localization of amyloid deposits as well as amyloid types. RESULTS: Amyloid deposits showed yellowish-green birefringence by DRHEP, which allowed identification of amyloidosis in 41 HE-unsuspected cases (P = 0.016), 31 of which only had vascular deposits. True positivity was higher, and false negativity and positivity were lower by DRHEP, compared to evaluation by HE (69%, 31%, and 0.8% vs 33%, 67%, and 33%, respectively; P < 0.0001). The sensitivity, specificity, accuracy, and positive and negative predictive values for DRHEP were 69%, 98%, 78.6%, 98.5%, and 61.25%, respectively. Reasons for DRHEP false negativity were presence of extensive background birefringence in 12 cases, absence of CR birefringent vessel in 3 cases, and missing of the tiny deposits in 9 cases, which could be improved by experience, especially in the latter case. No correlation was found between age, gender, sites of deposits, or amyloid types. CONCLUSION: The DRHEP technique improves diagnostic accuracy when used as an adjunct or a prior step to CR staining, especially for cases with limited tissues for further analysis.

Intravascular large B-cell lymphoma diagnosed on prostate biopsy: a case report.

Intravascular large B-cell lymphoma (IVLBCL) is a very rare type of non-Hodgkin lymphoma, usually affecting elderly patients and characterized by selective infiltration of neoplastic cells within blood vessels' lumina. IVLBCL diagnosed with prostatic involvement is extremely rare. We report a patient of 65 years old, having mostly neurological complaints but diagnosed with IVLBCL upon histopathological examination of transurethral prostate resection material, which revealed large neoplastic cell infiltration totally limited within the lumens of small vessels. By immunohistochemistry, neoplastic cell infiltration was positive with MUM1, bcl-6, and bcl-2 and negative with ALK1, CD10, and CD30, with a high Ki-67 proliferation index. CD34 and CD31 staining showed expression in endothelial cells, highlighting the intravascular nature of neoplastic infiltrate. The patient unfortunately refused to receive treatment and died of the disease 8 months after the diagnosis. IVLBCL, though very rare, should be considered in differential diagnosis of all organ biopsies with intravascular infiltration. Further improvements in the understanding of the pathogenesis and biology of this rare type of lymphoma are mandatory.

Is it possible to diagnose infectious oesophagitis without seeing the causative organism? A histopathological study.

BACKGROUND/AIMS: We investigated the utility of using histological changes to diagnose infectious oesophagitis when causative organisms cannot be seen. MATERIALS AND METHODS: Sixty-seven endoscopic biopsy specimens (51 Candida, 9 herpes simplex virus, 4 tuberculosis, and 3 cytomegalovirus oesophagitis) collected from 2000-2010 that matched the investigative criteria were included in the study. Cases were re-evaluated for histological changes observed in oesophagitis, and the findings were statistically compared using nonparametric tests. RESULTS: Thirty-nine cases occurred in male patients, and 28 occurred in female patients; the mean age of the patients was 51±20.1 years (range, 5-94 years). All cases showed lymphocytic and neutrophilic infiltration; while 27 (40.3%) showed eosinophilic infiltration. The density of lymphocytes and eosinophils were 8.43±6 and 1.07±1.62 per high power field, respectively, and these rates were higher in tuberculosis oesophagitis cases. Lamina propria infiltration was present in herpes simplex virus and Candida oesophagitis. Dense neutrophilic infiltration (>50/high power field) was noted in herpes simplex virus oesophagitis. Candida colonization was observed in 82% of cases with eosinophilic infiltration, and 80% of cases with erosion. Ulceration was present in all tuberculosis oesophagitis cases (p<0.001). Basal cell hyperplasia, papillary elongation, and dilated intercellular spaces were seen in all cases except for 2 Candida oesophagitis cases. Lamina propria fibrosis was especially noted in cytomegalovirus oesophagitis cases. CONCLUSION: It is not possible to distinguish infectious oesophagitis from other subtypes, especially reflux oesophagitis, if the causative organism is not detected. Clinicopathological correlation and control with repeat targeted biopsies are essential for diagnosis.

Multiple unrelated malignancies following renal transplantation: an evaluation of four cases.

The risk of de novo malignancy is significantly higher in patients who have undergone organ transplantation than in the general population. Long-term immunosuppressive treatment, in addition to age, genetic predisposition and infectious agents, plays a major role in the development of malignancy. Although skin and hemopoietic system cancers are common, atypical presentations of malignancies may occasionally be seen during long-term follow-up in patients with functioning allografts. In this report, four cases, each with more than one different primary malignancy (one patient with three malignancies and three patients with two malignancies), are presented.

Predictive and prognostic values of Tau and BubR1 protein in prostate cancer and their relationship to the Gleason score.

The aim of this study is to detect the expression levels of spindle assembly checkpoint protein-BubR1 and microtubule-associated protein-Tau in human prostate cancer tissues of different Gleason score, and to test whether there is a relationship between their expression levels and clinicopathologic parameters including response to docetaxel treatment, Gleason score, and overall survival (OS). Moreover, to test whether Tau protein expressed in the cancerous prostate tissue is phosphorylated. Thirty patients who received at least three cycles docetaxel for metastatic castrate-resistant prostate cancer were included into the trial. The patients' formalin-fixed and paraffin-embedded prostate tissue specimens were retrospectively obtained from the pathology department archives of Ege University School of Medicine. The expression status of BubR1 protein was defined by immunohistochemical (IHC) using the anti-BubR1 antibody. The expression status of Tau protein was defined by IHC using the two types of Tau antibodies: anti-Tau-1 antibody (that recognizes Tau only in its dephosphorylated form) and anti-PHF-Tau antibody (that recognizes all isoforms of human Tau proteins independent of its phosphorylation status). The BubR1 and Tau were overexpressed in about 63 and 23 % of the study group, respectively. Tau overexpression was significantly associated with lower Gleason score. There was no significant association between the expression levels of BubR1 and Tau proteins, and docetaxel response. Reduced BubR1 expression was strongly associated with longer survival (P = 0.008), whereas Tau expression status did not effect survival. Moreover, the Tau expression of cancerous prostate tissue was highly dephosphorylated. In this clinicopathological study, our findings did not confirm the preclinical observations that low BubR1 and Tau expression confer selective sensitivity to microtubulisin drugs. Our data imply that reduced BubR1 expression was a predictor for longer OS, and the possibility that high Tau expression may be involved in better prognosis due to its relationship to the Gleason score. Furthermore, our data suggest that both Tau and BubR1 may be a promising prognostic marker rather than predictive marker in patients with prostate cancer.

A horseshoe kidney from a live donor as a renal transplant: case report.

OBJECTIVES: This case report presents our experience regarding a horseshoe kidney from live donor to be used as a renal transplant. MATERIALS AND METHODS: The recipient was a 48-year-old man with chronic renal failure owing to hypertension who had been on hemodialysis for 2 years. The donor was his 43-year-old sister who had an uncomplicated horseshoe kidney with negative results on a urinalysis. An aortogram showed that the arterial supply to the kidney consisted of 2 superior arteries (1 on each side) and 1 inferior accessory artery that was divided to feed the lower fused parenchyma of the kidney. RESULTS: Surgery was performed via a retroperitoneal lumbotomy incision; the left half of the kidney was mobilized. The left kidney was procured by clamping the inferior accessory renal artery, transecting the parenchyma within the demarcation boundary. The transplant kidney was placed in the recipient's contralateral iliac fossa. The graft vein was anastomosed to the recipient's external iliac vein, the artery to the external iliac artery, and the ureter to the bladder. After perfusing the graft, no urine leakage was detected from the transacted surfaces, and the graft began producing urine. There were no complications after surgery. The patient was discharged on the 10th day after surgery with a creatinine level of 0.07 µmol/L. Maintenance immunosuppressive treatment included tacrolimus, mycophenolate mofetil, and prednisolone. CONCLUSIONS: We believe using a horseshoe kidney as a renal allograft after a detailed preoperative evaluation may help expand the donor pool.

Spectrum of nontumoral renal pathologies in tumor nephrectomies: nontumoral renal parenchyma changes.

Non-neoplastic changes are not rarely seen in renal parenchyma of nephrectomy specimens removed for primary renal neoplasms. These changes often involve both kidneys, thus causing impairment of renal function, reducing patient's quality of life and sometimes threatening it. Renal tissue accompanying the tumor provides an opportunity in order to evaluate these changes. However, the clinician should make available clinical and laboratory findings involving renal functions of the patient to the pathologist. It is also important that the pathologist must have appropriate knowledge and experience in nephropathology. In this study, we aimed to correlate these changes with the clinical data and make inquiries regarding our experience with nonneoplastic kidney pathology. Consecutive 403 nephrectomy specimens with primary renal neoplasms submitted to our department between 2003 and 2009 were re-examined. Twenty-three nephrectomy materials from 21 patients had non-neoplastic changes, 2 of which were bilateral. Patient follow-up data were obtained from electronic medical records. Of all cases, eight had diabetic nephropathy; 2, amyloidosis; 5, segmental proliferative and/or sclerotic glomerulonephritis; and 6, cystic renal changes. These findings were seen in 5% of nephrectomy specimens diagnosed as clear cell renal cell carcinoma (RCC), chromophobe cell RCC and oncocytoma, whereas this rate was two times higher in nephrectomy specimens with papillary RCC. Most patients with renal failure who were diagnosed with clear cell carcinoma died within the first two years. Despite limited number of cases in our series, prognosis of cases with clear cell RCC were poorer. Consequently, we think that non-neoplastic changes should be reported along with the details regarding the tumor in order to achieve best treatment planning.

Pauci-immune necrotizing crescentic glomerulonephritis with crescentic and full moon extracapillary proliferation: clinico-pathologic correlation and follow-up study.

The prognostic value of the type and extent of extracapillary proliferation (ECP) in pauci-immune necrotizing crescentic glomerulonephitis (PIGN) was evaluated in this study. In 141 PIGN cases, all glomeruli with ECP were grouped according to type (cellular, fibrocellular and fibrous) and extent of the lesions in Bowman's space; (segmental, semicircumferential and circumferential, which might be termed full moon-FM). Cases with cellular and fibrous lesions involving ≥ 50% of glomeruli with ECP were classified as cellular and fibrous groups, respectively, while the remaining cases were classified as fibrocellular. Cases with segmental and circumferential (FM glomerulus) lesions involving ≥ 50% of glomeruli with ECP were classified as ECPI and ECPIII (FM) groups, respectively, while the rest were classified as ECPII. All the cases were classified according to Berden et al. Significant results were only nearly obtained for the FM group, including the need for dialysis. The Cox regression model revealed a 2.6-fold risk for FM cases regarding dialysis requirement. We propose that the percentage of FM glomeruli should be noted in the pathology report, and cases with more than 50% of FM glomeruli (FM group) should be identified in the group with increased risk of dialysis requirement. Our series also suggests that classification according to Berden et al. is of clinical relevance.

Hepatic amyloidosis: morphologic spectrum of histopathological changes in AA and nonAA amyloidosis.

In hepatic amyloidosis (HA), the relationships between the pattern and extent of amyloid deposition, morphologic changes, associated diseases and clinical data have not yet been demonstrated. In this study, we sought the correlation between the above mentioned parameters in HA. Liver biopsies of 34 HA were retrospectively analyzed for the type, distribution, and intensity of amyloid deposition and associated morphologic changes. AA and nonAA types were classified on the basis of immunohistochemistry. Follow-up clinical and laboratory findings were reviewed. Twenty-three out of 34 patients (67.6%) had AA, and 11 out of 34 patients (32.4%) had nonAA amyloidosis. The predominant localization pattern in AA amyloidosis was vascular (91.3%), and in nonAA amyloidosis it was mixed with other patterns (72.7%). We confirmed that nonAA amyloid involves the hepatic artery, as well as the portal and central vein, but deposition occurred more frequently in the sinusoidal areas. We detected a portal stromal pattern only in cases of nonAA amyloidosis with a mixed pattern of amyloid deposition. The pattern of amyloid deposition in liver differs between the AA and nonAA type amyloidosis. The distribution of amyloid within the liver is not a reliable method for distinguishing AA from nonAA amyloidosis. However, the histological pattern provides strong clues as to the etiology of the amyloid deposits, and could provide information on the clinical status and prognosis of these patients.