Heavy chain deposition disease in a case of clear cell renal cell carcinoma- A jack in the box

Renal cell carcinoma (RCC) is the most common subtype of adult renal tumors, and its detection rate in the early stages has been increased in the dawn of advanced imaging modalities. Nephrectomy is the mainstay of treatment; determination of tumor category and staging is the primary concern of oncopathologists. Non-neoplastic renal parenchyma is overlooked majority of times and thus misses the opportunity to detect concomitant medical renal diseases which also predict the renal outcome in the postoperative era. Although any kind of glomerular or extraglomerular pathology may be encountered, vascular changes in the form of arterionephrosclerosis are the commonest one. Here, we take the opportunity to report an unusual association of heavy chain deposition disease (HCDD) with clear cell subtypes of renal cell carcinoma in a 48-year-old male of Indian ethnicity.

Role of light and immunofluorescence microscopy to differentiate primary and secondary membranous nephropathy

Context: Membranous nephropathy (MN) causes nephrotic syndrome, mostly primary but may be associated with SLE, infections, cancer, or drug. Aims: To estimate clinical, serological, light microscopic, and direct immunofluorescence (DIF) findings to differentiate primary and secondary MN. Settings and Design: Prospective, cross-sectional, single-center study in a tertiary care hospital. Methods and Material: Total 51 cases from September 2019 to February 2020. Laboratory Data: Blood glucose, urine analysis, urea, creatinine, albumin, cholesterol, HBsAg, Anti HCV, ASO, ANA, MPO ANCA, PR3 ANCA, dsDNA, PLA2R, C3, and C4. Clinical parameters: age, sex, BP, skin lesions, arthralgia, edema, obesity. Renal biopsies examined with H and E, PAS, silver methanamine, MT stains. DIF done with IgG, IgM, IgA, C3c, C1q, kappa, and lambda. Statistical Analysis Used: Statistical software (Graph Pad PRISM 6) and Chi-square test). Results: Among 51 cases, 25 are primary and 26 are secondary MN with 22 being lupus nephritis, with 2 being post-infectious and the remaining 2 being proliferative glomerulonephritis with monoclonal immunoglobulin deposition (PGNMIDD) with kappa chain restriction. Mean age was 37 ± 12.18 and 30.69 ± 13.92 years for primary and secondary MN, respectively. Significant male preponderance in primary MN. Serum C4 significantly low in secondary MN (15.34 ± 9.59). Microscopic hematuria present in secondary MN. Mesangial and endocapillary hypercellularity are significant in secondary MN. IgG and kappa are significantly intense in primary whereas IgA, C3c, and C1q are significantly intense in secondary MN. Conclusions: Reliable differentiation between primary and secondary MN has important therapeutic implications.

Pulmonary function in aluminium smelter and surrounding community--a case study.

The increase of industrial activities in the Angul-Talcher area, Orissa resulted in indiscriminate disposal of waste into the environment leading to the deterioration of the quality of the environment, which affects the health of the workers as well as the community people. Considering the magnitude of the problem, the pulmonary function study had been carried out in one of the largest aluminium producing plant of the country as well as surrounding community people. Aluminium is produced from oxides of alumina by Hall-Heroult smelting process. The electrolysis called as aluminium smelting is carried out in an electrolytic cell (pot) having anode, cathode and electrolyte. The aluminium is deposited in the cathode and the oxygen moves towards anode is released. The workers working at the captive power plant (CPP), which is necessary to meet the power demand of the smelter plant were also investigated. 180 smelter plants workers (non-smoker 129, smoker-51) of different sections and 37 captive power plant workers (non-smoker 29, smoker-8) had undergone pulmonary function tests. Besides these, 85 persons from the surrounding community (non-smoker-66, smoker-19) were also investigated. The workers were all male. Spirometric assessments of Vital Capacity (VC), Forced Vital Capacity (FVC), and Peak Expiratory Flow Rate (PEFR) were done by Spirovit-sp-10 (Schiller Health Care Ltd, Switzerland) and Wrights Peak flow meter (Clement and Clarke, UK). Different lung volumes like FEV1, FEV1%, and flow rates like FEF200-1200ml, FEF25-75% and FEF75-85% were calculated from the same tracings pulmonary function test (PFT) results of the workers according to different age groups, duration of exposures and smoking habits. The mean values of SVC, FVC and FEV1 of smelter plant workers were found higher compared to the community people but the values of captive power plant workers were very much close to the values of the community people. A gradual decrement of the PFT values was found as duration of exposure increased. Lung volumes and the flow rates were decreased as age increases but in some age groups that trend was not followed. It has been found that in each category of subjects, smokers have the higher mean pulmonary function values compared to the non-smokers. Except the community people in all other cases the different flow rates were found higher in nonsmokers compared to smokers. The restrictive, obstructive and combined restrictive and obstructive types of impairments among the subjects were noticed. The respiratory impairment among the workers as a whole was found higher in smelter plant workers (9.44%) followed by the captive power plant workers (5.40%) and the community people (2.35%). In smelter plant workers both the restrictive and obstructive impairments were found higher compared to captive power plant and the community people.

Respiratory health status of the roadside school children at Kolkata.

School students in metro cities are often exposed to vehicle exhausts as their schools are situated mostly on the high traffic roadside. Acute exposure to automobile exhaust is associated with increased respiratory symptoms and may decrease and impair lung function in children. The lung functioning performance of the city school children was compared with rural school children where there is no pollution and automobile exhausts. In Kolkata, two schools for boys (n = 210) and two schools for girls (n = 200) and in rural area one school for boys (n = 99) and the other school for girls (n = 95) were investigated. City schools are situated on the main roadside, nearer to the traffic junction. The detail histories about health status of children, if they have any subjective feelings of health related problems during the school hours or after returning from the school, and the family histories were taken by questionnaire method. The pulmonary function tests (PFT) were carried out by Spirometric method by Spirovit-Sp-10 and Wright's Peak flow meter. The mean PFT values of the students found in the normal range. Boys were having higher values compared to the girls in both city and rural schools. Lung volumes and flow rates were significantly higher in rural students. Symptomatic changes like breathlessness, cough and other problems (sneezing, eye irritation, running nose etc.) among city schoolboys found 13%, 7% and 15% and in girls found 12%, 6% and 7% respectively. In symoptomatic students, mean PFT values were significantly lowered compared to non-symptomatic. PFT values were presented in relation to age and height. It has been found that a number of city school students are having different types of respiratory symptoms. Long-term effect of exposure into such environment may develop lung functional impairments.

Blood donation and risk of post-transfusion hepatitis.

A survey was conducted among 300 blood donors of urban and rural population (the Sunderbans) and paid donors to evaluate the nutritional status, serum proteins, immunoglobulin and alanine aminotransferase (ALT) on the persistence of carrier state for post-transfusion hepatitis (PTH). Paid donors showed lowering of serum albumin and elevation of immunoglobulin and ALT. Nutritional and immunoglobulin profiles of rural donors of the Sunderbans, differed from those of voluntary donors of urban area. In the presence of subclinical hepatitis, ALT measurement alone is not a reliable guide for identification of individual carriers.