Figure 4 Tissular changes in crystalline CKD

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Figure 4 Tissular changes in crystalline CKD Figure 4 | Tissular changes in crystalline CKD. a | Calcium oxalate crystals (white arrow) deposited in murine kidneys visualized by ultrasonography as a 'stony kidney'. b | Uric acid tophus (black arrow) found in a renal biopsy sample (trichrome stain) of a 56-year-old patient with a history of hypertension and gout, proteinuria (2.8 g per day) and IgA nephropathy. Urate crystals are surrounded by inflammatory cells including giant cells (seen in haematoxylin and eosin-stained biopsy samples (not shown here)). Images courtesy of Helen Liapis, Arkana Laboratories, USA. c | Cystine needle-shaped crystals (black arrow) in interstitial macrophages from a patient with cystinosis. The crystals are water-soluble and appear colourless on formalin-fixed tissue stained with toluidine blue. Images courtesy of Helen Liapis, Arkana Laboratories, USA. d | 2,8-dihydroxyadeninuria (DHA) crystals (abundant brown tubular deposits, black arrow) in haematoxylin and eosin stained biopsy samples of a middle-aged adult with chronic kidney disease diagnosed with DHA disease on the basis of decreased adenine phosphoribosyltransferase (APRT) enzyme activity on blood spot. DHA disease due to APRT deficiency leads to conversion of adenine to DHA, which is insoluble and can lead to either nephrolithiasis or crystalline nephropathy. Image courtesy Stanley de Almeida Araujo, Bello Horizonte, Brazil. Image courtesy Stanley de Almeida Araujo, Bello Horizonte, Brazil. Mulay, S. R. & Anders, H.-J. (2017) Crystal nephropathies: mechanisms of crystal-induced kidney injury Nat. Rev. Nephrol. doi:10.1038/nrneph.2017.10