Idiopathic necrotising granulomatous interstitial nephritis.

We report a case of idiopathic necrotising granulomatous interstitial nephritis seen as an incidental autopsy finding in a 65 years female. The unusual features were the presence of necroses, with a florid, bizarre giant cell reaction. There were varying degrees of tubular damage, with relative sparing of glomeruli. There was no history of drug ingestion; Mycobacteria, fungi or crystals were not identified.

Haemangiopericytoma of kidney: a report of 2 cases.

Haemangiopericytoma is a rare neoplasm of the kidney. There are no unique radiological or clinical identifiers that can aid in preoperative diagnosis. Surgery is the only reliable therapy, as both chemotherapy and radiotherapy have proven ineffective in several series. The outcome is difficult to predict, the only reliable predictor is presence or absence of metastasis. The rarity of this lesion prompts the report of these two cases.

Haematuria: glomerular or non-glomerular?

The standard urinary sediment of 80 consecutive patients with significant haematuria admitted at our hospital was examined for significantly dysmorphic red blood cells by 3 methods-1. Phase contrast microscopy, 2. Wright's staining of the urinary sediment, and 3. Simple light microscopy. The results of the study were compared with the final diagnosis reached in the ward and the sensitivity of the three methods was statistically compared. Our study conclusively proves that phase contrast microscopy is superior to light microscopy of plain or Wright's stained urinary sediment, with respect to both sensitivity and percentage of dysmorphism of the urinary red blood cells which can be detected.

Study of intrarenal vasculature in cases of primary and secondary hypertension (by metallic impregnation technique on whole kidney section)

Study of intrarenal vasculature was carried out by using the metallic impregnation technique on whole kidney sections in 31 [corrected] cases of (primary and secondary) hypertension and 10 normal controls. Distinct patterns of intrarenal vasculature were noted in controls and in cases of hypertension. Gradual tapering of vessels, absence of tortuosity and good peripheral vascularisation were noted in controls. Abrupt tapering, tortuosity of vessels and poor peripheral vascularisation were noted in hypertensive cases. In essential hypertension moderate to severe changes of dilatation of the segmental and/or arcuate arteries was noted. The degree of dilatation was related to the level of systolic BP rather than diastolic in cases of essential hypertension. Secondary hypertension even if severe, rarely showed significant dilatation lesions. Avascular zones and conglomeration of vessels at poles was seen only in cases of pyelonephritis. This helped in distinguishing these, from cases of glomerulonephritis.

Fine needle aspiration cytology (FNAC) in the evaluation of acute renal allograft rejection.

310 Fine needle aspirations biopsies (FNAB) were performed in sixty-five live related renal donor transplant recipients in a prospective study over 2 years. 82.8% of FNAB were adequate for opinion and there were no complications after the procedure. Methodology used and interpretation of FNACs was as described by Von Willebrand and Hayry. The procedure of FNAC had a sensitivity of 83.3%, specificity of 98.3% and accuracy of 96.1%, and statistically significant (p < .001) correlation was noted between FNAC and Needle biopsy. The increment in lymphoblasts, lymphocytes and score above 3 was suggestive of acute cellular rejection. Increment in monocytes and macrophages above 1% in addition to other cells, was suggestive of acute vascular rejection. FNAC was found to be a safe, simple and easy procedure with high specificity and sensitivity.

Nonfunctioning adrenocortical carcinoma.

The rarity of adrenocortical carcinoma prompted us to report a case who came with a history of swelling in the left flank associated with pain, weakness and loss of appetite. Ultrasonography revealed a left retroperitoneal mass which was removed by radical surgery along with the left kidney and spleen. On histopathological examination, a diagnosis of adrenocortical carcinoma was made. (Hough criteria score 2.97). The cells of the tumor were arranged in closely packed columns and cords supported by fibrovascular stroma. There was no evidence of metastasis.

Solitary retroperitoneal angiofollicular lymph node hyperplasia.

The fine needle aspiration cytology (FNAC) and ultrasound radiologic features of a solitary retroperitoneal angiofollicular lymph node hyperplasia (AFLNH), hyaline vascular type are described. Based on a combination of the two, this diagnosis can be suggested in the differential diagnosis of a retroperitoneal mass.

Actinomycotic pseudo-tumour of the mid-cervical region (a case report).

Cervicofacial actinomycosis is today a rare disease in our country. Isolated actinomycotic neck masses are extremely rare. A case of young man with an isolated midcervical tumour like actinomycotic granuloma without sinuses or discharging granules is reported here.

Methyl alcohol poisoning: an autopsy study of 28 cases.

Twenty eight fatal cases out of the 97 cases of methyl alcohol (MA) poisoning admitted to K. E. M. Hospital in August 1988 during a single outbreak were studied. The latent period between consumption of the drink and development of symptoms was variable (range 7 1/2 hours to 60 hours). CNS symptoms were predominant (75% of cases) and shock either at admission or as a late event was seen in 89% of the cases. Blurring of vision was seen in 42.8% and blindness in 10.7% of cases. Minimum fatal period was 7 1/2 hours and maximum was 12 days. Methanol levels in blood and viscera were variable (average 155.8 mg%, max. 420.4 mg%). In 4 cases, significant amount of MA was detected in stomach contents 5-12 days after consumption of MA, raising the question of resecretion of MA in stomach. Shrinkage and degeneration of neurons in the parietal cortex was seen in 85.7% of cases. Putamental degeneration and necrosis was seen in 7.14%. Haemorrhage (3.5%) and sponginess (7.14%) was observed in the optic chiasma. Severe renal tubular degeneration and patchy necrosis was seen in all cases. Fatty changes (67.8%) and microvesicular fat (42.5%) were seen in the hepatocytes.

Pattern of renal amyloidosis in western India. A study of 104 cases.

A total of 31,266 autopsies and 1556 renal biopsies were scrutinised over a period of 19 years (1968-1986) retrospectively and prospectively, with an aim to study the incidence and pattern of renal amyloidosis in western India. A total of 104 cases with amyloidosis were detected, 41 from the autopsy series (0.1%) and 63 from biopsies (4%). Secondary amyloidosis was seen in 83.7% and primary amyloidosis in 11.5%. The interval between the onset of predisposing disease and first evidence of amyloidosis varied from 2 months to 31 years. Tuberculosis of various organs was the main cause of secondary amyloidosis (72.4%). Nephrotic syndrome was a common mode of presentation (71.4%). Besides kidneys, which were involved in all cases, the liver, spleen and adrenals were other commonly involved organs at autopsy. Renal failure was the leading cause of death (34.1%).

Xanthogranulomatous pyelonephritis--(a clinicopathological study of 15 cases)

The clinico-pathological features of 15 patients with xanthogranulomatous pyelonephritis (XGP) are described and the probable histogenesis is discussed. Based on our data and the review of literature, we believe that XGP should be regarded as a destructive and at times tumefactive inflammatory process that may complicate chronic pyelonephritis. The initiation of this process remains obscure, but the features commonly associated with XGP are pelvi-calyceal obstruction, ulceration of the pelvic urothelium with collection of necrotic material and bacterial infection.

Spectrum of histological lesions in 185 consecutive prostatic specimens.

One hundred and eighty five consecutive prostate specimens were studied. The predominant lesion noted was benign prostatic hyperplasia (B.P.H.) (92.97%). The incidence of carcinoma was low, (7.02%). Conditions which can mimic and should be considered in the differential diagnosis of carcinoma, like basal cell hyperplasia, atypical hyperplasia and atrophy associated hyperplasia were noted in 10, 4 and 3 cases of B.P.H. respectively. None of these cases showed evidence of carcinoma. Corpora amylacea were noted in 38.91% of the cases of B.P.H. and were conspicuously absent in cases of carcinoma. Chronic prostatitis was frequently encountered (58%) and metaplastic changes were seen in 11% of the cases.

Clinicopathological study of acute renal failure following viperine snake bite.

Fifty patients of acute renal failure following Viperine snake bite were studied. Oliguria (100%), local swelling (48%) and bleeding tendencies (42%) were the predominant clinical features encountered. Of the 25 patients in whom detailed coagulation studies were done, 24 patients had disseminated intravascular coagulation (DIC) and 1 had primary fibrinolysis. DIC was commoner with Russell's viper bite (62%) in comparison to Echis carinatus bites (40%). Renal histology obtained in 29 cases revealed tubular necrosis (35%), cortical necrosis (24%) tubular degeneration (17%) and glomerular changes (17%). Ballooning of glomerular capillaries (59%), splitting of glomerular basement membrane (40.7%), swelling of endothelial cells (29.6%), and focal proliferation of mesangial cells (17%) were the significant glomerular changes encountered. 20 (40%) patients succumbed, DIC (50%), irreversible shock (30%) and septicaemia (20%) being the immediate causes of death. Development of oliguria within 24 hours of snake bite and cortical necrosis were associated with higher mortality.