1. Renal Pathology, Case 3 A 41-year-old woman presents with complaints of foot and leg swelling gradually worsening over the past month. She also notices that she is “puffy around the eyes” after waking up in the morning. Physical Examination: BP 140/88, Pulse 80. There is bilateral lower extremity edema extending to the thighs and bilateral hand edema. Remainder of the physical exam is unremarkable.

2. UA w/Micro Color Yellow [YELLOW] pH 6.0 [4.5-8.0] Spec Gravity 1.020 [1.003-1.035] Protein 4+ [NEG] Blood Neg [NEG] GlucoseNeg [NEG] Ketones Neg [NEG] BilirubinNeg [NEG] Urobilinogen 0.2 [0.2-1.0] eu/dl Nitrate Neg [NEG] LeukocyteNeg [NEG] RBC 0 [0-2] /hpf WBC 0 [0-5] /hpf +oval fat bodies

3. Oval Fat Bodies What are they? What is the significance? Oval fat bodies are renal tubule epithelial cells in which globules of lipid have become visible. These deformed cells are frequently associated with nephrotic syndrome.

4. Oval Fat Bodies When viewed under polarized light, this renal tubular epithelial cell is laden with numerous fat droplets which appear refractile. Polarized light

5. Amyloidosis The microscopic section of the kidney reveals homogenous pink deposits of amyloid in the mesangium. Special stains are required to verify the presence of amyloid Describe the histologic changes amyloid

6. Amyloidosis The electron micrograph of the kidney reveals a high power view of the edge of a glomerular capillary. Note the large deposit of amyloid protein in the subendothelial basement membrane. The amyloid fibrils (asterix) are like fine hairs. Correlate with the previous histologic picture of renal amyloidosis. Describe the syndrome associated with this disease. A – Endothelium B – Capillary lumen C – Red blood cell