.

LPL – MEDICA LABORATORY SERVICES

MAHABOUDHA-24,
BESIDE BIR HOSPITAL
KATHMANDU

Name : Mr. BINOD RAI Collected: 17-11-2021 07:34:00

Received: 18-11-2021 07:46:06
Lab No. : 310665133 Age : 30 Years Gender: Male Reported: 20/11/2021 17:14:28

A/c Status : P Ref by : TUTH Report Status: Interim

RENAL PATHOLOGY REPORT @ **

SPECIMEN : Kidney biopsy panel 3

CLINICAL HISTORY : K/C/O Nephrotic syndrome, HTN, hypertensive urgency 1 month back,
S. creatinine 1.9 mg%, 24 hours urine protein 5 gm, serum albumin 31.
S. cholesterol 670 mg%, ANA, anti dsDNA, ANCA - negative.

GROSS : 1. Received 1 linear tissue core measuring 1.7 cm in formalin

2. Received 1 linear tissue core measuring 1.2 cm for DIF studies.
[Entire tissue : 10324/21]

MICROSCOPY : Multiple sections stained with H&E, PAS, Silver methenamine, MT and Congo
red include renal medulla & cortical parenchymal core containing upto 16
glomeruli, four (25%) are globally sclerosed. Viable glomeruli show mild increase
in mesangial cellularity & matrix and few show segmental endocapillary cellularity
with intracapillary neutrophil & mononuclear cell margination. Peripheral
glomerular capillaries do not appear thickened. Five (31.2%) glomeruli show
segmental tuft sclerosis and two (12.5%) reveal crescent formation (one cellular
& one fibrocellular). Active tuft necrosis is not observed.

Tubular atrophy and interstitial fibrosis involve about 25-30% of sampled cortex.
Tubules show focal cytoplasmic vacuolar change. Scattered hyaline & granular
casts are seen in tubular lumina. Multifocal chronic interstitial inflammation is
noted.

Arteries show medial thickening, while arterioles exhibit hyalinosis lesions and

Note: 1. Slides / Blocks can be issued only on advise of the referring consultant after a minimum of 48 hours.
2. Gross specimens will be retained only for a period of 1 month after the date of reporting.
3. Contact histopathology department for any clarification.
Page 1 of 3
*310665133*
.

LPL – MEDICA LABORATORY SERVICES

MAHABOUDHA-24,
BESIDE BIR HOSPITAL
KATHMANDU

Name : Mr. BINOD RAI Collected: 17-11-2021 07:34:00

Received: 18-11-2021 07:46:06
Lab No. : 310665133 Age : 30 Years Gender: Male Reported: 20/11/2021 17:14:28

A/c Status : P Ref by : TUTH Report Status: Interim

vacuolization in smooth muscle cells of media.

DIF : Tissue for DIF contains renal cortical parenchyma containing upto 8 glomeruli.
Following immunostaining pattern is observed:

PARAMETER RESULT
IgA 3+ mesangial; granular
IgG Negative
IgM Negative
C3 2+ mesangial; granular
C1q Negative
Kappa Light chains 2+ mesangial; granular
Lambda Light chains 3+ mesangial; granular

IMPRESSION : Kidney, needle biopsy:

1. Mesangial and focal endocapillary proliferative IgA nephropathy,

featuring crescents over 2/16 (12.5%) glomeruli (one cellular & one
fibrocellular) and segmental sclerosis lesions in 5/16 (31.2%) capillary
tufts.

2. Moderate increase in tubulointerstitial chronicity is seen.

3. MESTC scores (Oxford classification of IgA nephropathy)*

Mesangial hypercellularity (M score >0.5): M1

Endocapillary cellularity (present): E1

Segmental sclerosis (present) S1

Tubular atrophy/interstitial fibrosis (>25%): T1

Crescents (cellular / fibrocellular) (< 25%): C1

*Please see comments below

COMMENTS : According to the Oxford Classification for IgA nephropathy, scores of M1 and S1
indicate mesangial hypercellularity and segmental glomerulosclerosis,
respectively, and by themselves indicate a mildly increased risk of renal
functional deterioration. However, M1 and S1 together suggest a considerable

Note: 1. Slides / Blocks can be issued only on advise of the referring consultant after a minimum of 48 hours.
2. Gross specimens will be retained only for a period of 1 month after the date of reporting.
3. Contact histopathology department for any clarification.
Page 2 of 3
*310665133*
.

LPL – MEDICA LABORATORY SERVICES

MAHABOUDHA-24,
BESIDE BIR HOSPITAL
KATHMANDU

Name : Mr. BINOD RAI Collected: 17-11-2021 07:34:00

Received: 18-11-2021 07:46:06
Lab No. : 310665133 Age : 30 Years Gender: Male Reported: 20/11/2021 17:14:28

A/c Status : P Ref by : TUTH Report Status: Interim

risk of such deterioration.

Tubular atrophy/interstitial fibrosis (T) scores of T1 and T2 indicate progressively

greater risk of renal functional decline compared with T0, and augment the
poorer prognosis associated with M1 and S1.

Endocapillary proliferation (E1), if present, suggests a lesion that may improve

with immunosuppressive therapy.

Crescents (cellular / fibrocellular) when present are considered independent

predictors of progressive renal impairment and disease outcome.

References : Roberts ISD et. al. Kidney International (2009) 76, 546-556.
Cattran DC et. al Kidney International (2009) 76, 534-545.
Trimarchi H et. al Kidney International (2017) 91:1014-1021

NOTE : Ultrastructural examination report will follow.

HISTOPATH NO : [ LPL/B/10324/21 : ET ]

Dr Alok Sharma
MD, Pathology
Technical Director - Renal
Pathology & Transmission
Dr Garima Garg Electron Microscopy
MD DNB,Pathology NRL - Dr Lal PathLabs Ltd
Dy. HOD - Renal & EM
NRL - Dr Lal PathLabs Ltd

Note: Case reported by Dr Garima Garg

** Test conducted under NABL scope MC-2113, LPL-NATIONAL REFERENCE LAB at NEW DELHI

IMPORTANT INSTRUCTIONS

Test results released pertain to the specimen submitted. All test results are dependent on the quality of the sample received by the
Laboratory.Laboratory investigations are only a tool to facilitate in arriving at a diagnosis and should be clinically correlated by the Referring Physician.
Sample repeats are accepted on request of Referring Physician within 7 days post reporting. Report delivery may be delayed due to unforeseen
circumstances. Inconvenience is regretted. Certain tests may require further testing at additional cost for derivation of exact value. Kindly submit request
within 72 hours post reporting. Test results may show interlaboratory variations. The Courts/Forum at Delhi shall have exclusive jurisdiction in all
disputes/claims concerning the test(s) & or results of test(s). Test results are not valid for medico legal purposes. Contact customer care Tel No. +91-11-
39885050 for all queries related to test results.

(#) Sample drawn from outside source.

Note: 1. Slides / Blocks can be issued only on advise of the referring consultant after a minimum of 48 hours.
2. Gross specimens will be retained only for a period of 1 month after the date of reporting.
3. Contact histopathology department for any clarification.
Page 3 of 3
*310665133*