1. The NEPTUNE Pathology Scoring System: Examples of descriptors.
The NEPTUNE Pathology Scoring System: Examples of descriptors. (A) Multi-level representation of a glomerulus annotated as glomerulus 3 throughout various levels. Although on level 1 there are no lesions of segmental sclerosis or collapse and this glomerulus would be counted as nonsclerotic if viewed on one level only, the same glomerulus reveals two distinct lesions of segmental sclerosis with hyalinosis on levels 8 and 9 (periodic acid–Schiff and silver stain, respectively). There is one segmental lesion containing hyalinosis on level 11 (hematoxylin and eosin) and the glomerulus has no segmental lesions again on level 12 (hematoxylin and eosin). The histologic profiling of this glomerulus includes the following descriptors: segmental sclerosis with hyalinosis cannot determine location ×2, and hyalinosis cannot determine location. (B) This glomerulus stained with silver is characterized by three descriptors: segmental sclerosing tip lesion, hyalinosis away from the vascular pole ×2, and mid-glomerular hyalinosis. (C) Three descriptors are used to profile this glomerulus (silver stain): segmental proliferative collapse, segmental podocyte hyperplasia, and segmental podocyte hypertrophy. (E) Descriptors are applied to this case of membranous glomerulopathy with segmental sclerosis. Both features of sclerosis and membranous are scored (silver stain). (F) A case of membranous glomerulopathy is illustrated (silver stain on the left and trichrome on the right). Descriptors used to profile this glomerulus include the following: diffuse spikes/hopes and global podocyte hypertrophy. (D and G) Descriptors are also applied to electron microscopy analysis. D shows that there is 100% effacement; condensation of the actin-based cytoskeleton and microvillous transformation are also scored. Primary processes are scored as presented. G shows subepithelial electron dense deposits. NEPTUNE, Nephrotic Syndrome Study Network.
Laura Barisoni et al. CJASN 2013;8:
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