Write an essay on “Kidney in Humans Body”.
Just below the rib cage are the two bean-shaped organs called kidneys. Kidneys in human body performs one of the most important function- the blood filtration and waste product excretion. Glomerulus synonymous with filtration are tiny clusters of blood vessels present inside the kidney in which blood enters via branching out arteries. One kidney has approximately 1 million glomeruli in it. With Glomerulus (one glomeri) is attached a small fluid collecting tube called tubule. After the blood filtration in glomerulus the extra wastes and fluid passes through tubule and becomes urine. And finally, the kidneys through a large called ureter extreme the urine into the bladder (5).
A branch of pathology, Histopathology is a specialized study of the disease of the tissues by definition. Before the microscopic diagnosis of the tissues they must pass through a number of steps like fixation, embedding and staining. In order achieve a more correct diagnosis there is a need of a lot more accurate preparation such as enough fixation time, sufficiently thick or thin section, good quality staining and well embedding (7). Consequently, all the architecture will be well differentiated and clear. Moreover, H&E stain, special stain, in situ hybridization and immunohistochemistry are some of the different kinds of methods in Histopathology for diagnosis. Furthermore, stained tissues investigations through microscope is one of the best methods to get rapid and correct diagnosis. Besides using H&E, which is the routine stain, through this report, in the given tissue section we will try to identify and diagnose the abnormalities by using different kind of special stain. The microscopic examination result will help in finding the exact reason of patient symptoms (1).
Along with clinical history of the case study, H&E section was given. After microscopic examination of H&E section some disease has been assumed. Hence to identify the exact type of the disease, five special stains were taken into consideration to be performed on five unstained slides. First of all by using xylene the five slides along with five control slides were de-waxed and then hydrated by descending alcohols and further running tap water. Secondly, using different special stain as labeled each slide was stained. In the third step, by ascending alcohols all the sections were hydrated except that of gram stain slides, which were air-dried, then all the slides including gram stain slides were cleared with xylene. Further mounted by the use of DPX and then labeled. Finally, all the slides were microscopically examined and the results were recorded (6).
Kidney in humans is one of those organs, which have too many diseases associated to it such as renal cell carcinoma, pyelonephritis and glumurlnephritis. Therefore it requires a lot of experience to diagnose the correct disease. In our case, some of the glomeruli are showing as hypercellular and hyalinized in the H&E section, but it can be false appearance also as it is difficult to differentiate between mesangial cells and endothelial. In addition to that, there is presence of inflammatory cells in the H&E section. This could point towards inflammation of the kidney (9). Further, the patient is a young woman and looking at other clinical features like hematuria with pain and since women is at higher risk of kidney infection because of a shorter urethra compared to men, so in my initial diagnosis I suspect the patient has pyelonephritis. In order to be sure in diagnosing the disease and eliminate some of them it is suggested five special stains to be used. Those special stains are Masson Trichrome, Periodic acid Schiff, Gram Stain, and Ziehl-Neelsen’ method for acid fast bacilli and Grocott Methinoamne Silver. First I have chosen Gram Stain as it can distinguish between negative and positive gram bacteria. Some bacteria like E. coli or klebsiella through lower urinary tract system can reach kidney and are most causative bacteria for pyelonephritis, so in order to identify gram stain is needed and distinguish this type of bacteria if present (8). Secondly, in order to eliminate the possibility of renal tuberculosis Z-N stain were suggested to identify the presence of mycobacterium species that can cause the disease. It is possible that bovine tubercle bacillus is responsible for the disease but M. tuberculosis is the most common causative agent (10). Therefore to identify if tuberculosis is present or not Z-N stain is important to be performed. Thirdly, the GMS stain which demonstrates the presence of fungi. Cryptococcus, species candida and aspergillus are the fungal infection which have been reported to cause renal parenchymal, since the use of immunosuppressive therapy with organ transplantation has been increased. Fourthly, in renal biopsy to demonstrate and evaluate the amount of fibrous connective tissue the stain Masson Trichrome were suggested. In addition to that it will help in distinguishing between interstitial fibrosis and interstitial oedema. Furthermore it can easily calculate the lobular accentuation of the glomerular tufts and bowman’s capsule (11). Lastly, the stain PAS stain was suggested to evaluate the glomerulus as it is the best to do so and moreover it demonstrates bowman’s capsule and glomerulus basement membrane. Furthermore, PAS stain can easily picture the spread GBM thickening that is seen in many glomerulus infections such as diabetic glomerulopathy, hypertension and membrane glomerulonephritis. Moreover, PAS stain positively for sclerosis, hyaline deposits, proximal tubules and mesangial matrix. Therefore it is important to order PAS stain so as to correctly evaluate and demonstrate the most of kidney architecture.
Since the Z-N stain, gram stain and GMS are negative it can be concluded that no microorganism infection present in the kidney. Consequently as expected, fungal infection, pyelonephritis and renal tuberculosis are eliminated from the diseases list. But on the other hand fibrosis in the tissue is shown by masson trichrome which demonstrates the fact that infection is present in the kidney. It should be noted that if excessive collagen is present in the tissue, it suggests that the tissue is recovering from the chronic diseases. So clearly in this case, the kidney is regenerating after injury. Additionally the diffuse thickening of the glomeruli capillary wall was shown by the PAS stain (12). Glomeruli showed normal glomeruli, segmental scleroses are present though. Caused by the obstruction of blood flow there is presence of tubules with thick redundant basement membrane (tubular atrophy). Moreover, some of the bowmen’s capsule and glomeruli are replaced with a pink in color, homogeneous and amorphous material called hyaline (hyalinosclerosis) that is resulted from combination of increased collagen, plasma protein and mesangial matrix. Therefore depending on the clinical features and the given microscopically diagnosis the patient seems to have focal segmental glomerulosclerosis (FSGS). In adults, focal segmental glomerulosclerosis is one of the most possible causes of primary glomerular diseases. It is not necessarily a distinct disease and represents characteristic pathologic pattern of glomerular injury. The increased degree of scarring of some glomeruli (focal) in kidney biopsy is a sign for (FSGS), also only a portion of glomeruli in involved in the scarring dose (2). However, some normal glomeruli are also present which can be classified to collapsing glomerulopathy like primary (idiopathic) and HIV infection like secondary. In adult this condition is considered to be the predominant cause of idiopathic neghrotic syndrome and within 10 to 20 years, 40% to 60% of patients move further to end stage renal disease (ESRD).
To confirm the early diagnosis further tests should be done. In order to detect early signs of kidney damage, a urine microalbumin test should be done which will measure the protein amount present in the body (3). Additionally, in order to calculate the removal of creatinine, which is the waste product from the kidney, the glomerular filtration rate (GFR) is recommended. The above-mentioned two tests are useful in diagnosing the presence of lubus nephritis and diabetic nephropathy. Furthermore, it is recommended that some other special stains performed, for instance, to demonstrate amyloidosis, Congo red to be performed. Lastly, AE1/AE3 is an example of antibody and it is important to perform immunohistochemistry to diagnose renal cell carcinoma.
Conclusion:
To discover most of the diseases it is essential to perform microscopically diagnosis. However, quality in tissue processing in needed for correct diagnosis. Therefore it is necessary to have quality control in histopathology section. As there are numerous Kidney diseases, therefore there is a need of several tests in renal biopsy and special stains to get the correct diagnosis (4). Further, In this case, different results shown by special stains aided in eliminating some of the diseases and helped in giving the correct diagnosis. While special stains for microorganism gave the negative result, masson trichrome and PAS gave positive result. Therefore, it can be concluded that the patient suffers from the glomerular disease specifically that of FSGS (focal segmental glomerulosclerosis). Finally, other diseases like amyloidosis, diabetic nephropathy and renal cell carcinoma are suspected too, but in order to confirm them they need to be tested further.
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