The prevalence of C4d-positive renal allografts in 134 consecutive biopsies in Thai patients.

Antibody-mediated rejection (AMR) has been recognized recently as an important cause of graft failure. Detection of C4d in renal allograft biopsies is a proven ancillary technique in the diagnosis of AMR. The prevalence of C4d staining in Western countries varies from 17% to 60% among indication biopsies. There are only a few C4d prevalence studies in an Asian population. The objective of this study was to identify prevalence of C4d among Thai renal transplant patients. Consecutive renal allograft biopsies from 99 patients from 1999 to 2007 were stained for C4d by an immunoperoxidase technique. The biopsy slides were evaluated for the diagnosis according to the Banff'07 classification and histological scores. The relevant clinical data were obtained from clinical records. The prevalence of C4d in renal allografts was reported as a percentage using a descriptive analysis. Chi-square and unpaired Student t tests were used to evaluate the association between clinicopathologic findings and C4d positivity. P values less than .05 were considered significant. The prevalence of positive C4d staining was 16.4%. Fourteen biopsies (10.4%) showed diffuse staining while 8 (5.9%) revealed focal staining. Transplant glomerulopathy, glomerulitis, and peritubular capillaritis were associated with C4d positivity. Most inflammatory cells in peritubular capillaritis were mononuclear cells. Banff score elements, including tubulitis, intimal arteritis, interstitial infiltrate, interstitial fibrosis, tubular atrophy, mesangial matrix increase, vascular fibrous thickening, and arteriolar hyaline thickening, were not associated with C4d positivity. Many factors contribute to the varied prevalence of C4d positivity, including immunologic risks for AMR, type of allograft biopsy, and technique of C4d staining. Our study showed no difference in C4d prevalence among Thai renal allograft patients compared to the Western population. The suggestion to use C4d staining on all allograft biopsies should applied to Thai patients as well.

Congenital chylous ascites: the roles of fibrin glue and CD31.

UNLABELLED: A 6-month-old male infant who presented with abdominal distension and congenital chylous ascites was diagnosed. He was initially refractory to conservative therapy, and then was completely cured with ligation of megalymphatics and fibrin glue application. Immunoperoxidase staining for CD31 on the biopsied peritoneal tissues highlighted the lining cells of lymphatic spaces, which indicated lymphangiectasia. CONCLUSION: This case emphasizes the effectiveness of lymphatic ligation of the retroperitoneal megalymphatics in conjunction with fibrin glue application to cure congenital lymphangiectasia.

Evaluating the clinical course and prognostic factors of posttransplantation immunoglobulin A nephropathy.

INTRODUCTION: Previous reports have suggested that posttransplantation immunoglobulin (Ig) A nephropathy displays a relatively benign course, hardly ever affecting graft function. However, more recent studies with longer follow-up have shown that posttransplantation IgA nephropathy may be a significant contributor to graft loss. Additionally, there may be other clinical or pathological factors that affect long-term graft outcome. We retrospectively analyzed 30 kidney transplant recipients with biopsy-proven IgA nephropathy in their allografts to determine the clinical course and prognostic factors in posttransplantation IgA nephropathy. The median duration of follow-up was 36 months (range, 1 month-17 years). The median onset of IgA nephropathy was 33.6 months posttransplantation (range, 5 days-103 months). The most common presentation was an abnormal urine examination (96.6%). Fifteen (50%) displayed microscopic hematuria with proteinuria more than 1 g/d. Fifteen patients (50%) lost their grafts at a median time of 24 months after the onset of disease (range, 1-93 months). Allograft loss was associated with a high serum creatinine level at the time of diagnosis (3.68 +/- 2.23 vs 1.79 +/- 0.34 mg/dL; P = .006), a greater level of proteinuria at the time of diagnosis (2.43 +/- 0.76 vs 1.29 +/- 1.07 g/d; P = .003), and more than 50% extracapillary proliferation (P = .05). Fibrinoid necrosis on allograft pathology impacted 1-year allograft survival (P = .025). CONCLUSION: Posttransplantation IgA nephropathy worsens allograft outcomes among patients with increased serum creatinine level or significant proteinuria at presentation or significant glomerular inflammation and/or tubulointerstitial damage.

Renal pathology and long-term outcome in childhood SLE.

Renal histology is increasingly used as a guide for therapy and prognosis in SLE but data in children are few and/or short-term. We assessed renal histological features in 19 children with SLE to determine whether these features are useful in predicting long-term outcome. Mean age at biopsy was 10 +/- 1.7 years old, male to female ratio was 1:2.8. Fourteen patients (73%) had diffuse proliferative lupus nephritis. Renal histology was evaluated using an activity index (AI) and chronicity index (CI). Clinical assessment of renal function at biopsy and outcome were graded according to urinalysis and serum creatinine. Renal function at biopsy correlated well with AI (p < 0.001) but not CI. At short-term follow-up (30 months), 3 patients had died from sepsis and another 2 reached end-stage renal disease. CI predicted poor clinical outcome, i.e. death or renal failure (p < 0.005) but AI did not. At long-term follow-up (mean 92.1 +/- 26.8 months) only one more patient reached end-stage renal disease. In others renal function assessment showed improvement or were stable. Neither CI nor AI correlated with clinical outcome. We conclude that although AI correlates well with renal function at biopsy and CI with short-term prognosis, neither can predict long-term outcome. Treatment may have altered the natural course of disease in these patients.

Renal failure in two patients with Wolfram syndrome.

We describe a Thai family with three children, two of whom presented with Wolfram syndrome, which is a rare syndrome characterised by diabetes insipidus, diabetes mellitus, optic atrophy, deafness and urinary tract dilatation. A girl and her younger brother had insulin-dependent diabetes mellitus at 11 years old with early onset of renal impairment, proteinuria and hypertension. Urinary tract dilatation was demonstrated in both patients. Kidney biopsies were compatible with diabetic nephropathy. Both children also had bilateral sensorineural hearing loss. Optic atrophy with severe loss of vision was detected in the girl and bilateral cataract in her brother. Both patients were HLA DR2 positive. At 16 years old, her creatinine clearance was 16 ml/min/1.73 m2. Her brother's creatinine clearance was 25 ml/min/1.73 m2 at 13 years old. We conclude that renal function should be evaluated in patients with Wolfram syndrome and the cause of renal failure in these patients may be rapid and severe diabetic nephropathy.

Lupus nephritis in Thailand: clinicopathologic findings and outcome in 569 patients.

The prognosis of lupus nephritis patients in Thailand has been reported to be poorer than that in Western countries since 1978. After a great evolution in management, we re-evaluate the long-term outcome in patients who were treated and followed up at Siriraj Hospital in Bangkok from 1984 to 1991. Clinical and pathologic records were collected from 569 patients (515 females and 54 men) who were followed up for a mean period of 38.7 +/- 34.6 months. The mean age was 28 +/- 10 years and the median duration of symptoms prior to admission was 7 months. Hypertension was diagnosed in 32.4% of patients and 41.3% had serum creatinine greater than 1.5 mg/dL. Nephrotic-range proteinuria was found in 43.6% of patients and creatinine clearance less than 50 mL/min was found in 58.0%. Of the 314 patients who underwent renal biopsy, the most common histologic finding was diffuse proliferative glomerulonephritis (61.5%). The overall probability of survival was 76.5% at 60 and 90 months after diagnosis. Initial presence of hypertension, renal insufficiency (creatinine clearance < 25 mL/min), and World Health Organization histology class IV and III in the biopsied patients were the three independent factors significantly associated with lower survival probability. Neither gender nor amount of proteinuria was the predictive factor for poor outcome. During the follow-up period, 89 patients died and two patients entered a chronic dialysis program. The two leading causes of death were infection (50.5%) and uremia (28.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Glomerulonephritis in beta-thalassemia Hb-E disease: clinical manifestations, histopathologic studies and outcome.

We presented 8 patients with beta-thal/Hb E with glomerular diseases. Diverse glomerular lesions were seen, but diffuse endocapillary glomerulonephritis was the most common. The clinical manifestations of acute glomerulonephritis in beta-thal/Hb E differed from typical cases in the older age group, female preponderance, longer duration of edema, less hypertension, marked proteinuria, hypoalbuminemia and hypertriglyceridemia and also a longer period of recovery but their outcome was still favorable despite many risk factors of renal injury. Renal biopsy was necessary in doubtful cases to detect the correct diagnosis and give proper management. The association and mechanism of glomerulonephritis in these patients require further prospective study.

Lupus nephritis in males: 8-year experience at Siriraj Hospital.

During 1984 to 1991, 54 out of 569 lupus nephritis patients at Siriraj Hospital were male (F:M sex ratio = 10:1). Mean age of the males was 29.8 +/- 14.6 years, range 12 to 69. The three most common extrarenal manifestations were anemia, cutaneous, and musculoskeletal involvement (74.5, 51.1, and 43.9%, respectively). The major renal manifestations were edema (75.9%) with heavy proteinuria over 3.5 g/day in 62.2% and nephrotic/nephritic findings in 51.9% of cases. Hypertension was found in 35.2%. Mean serum creatinine was 2.0 +/- 1.4 mg/dl while 60.5% of cases had creatinine clearance below 50 ml/minute. Mean serum albumin was 2.6 +/- 0.8 g/dl, cholesterol 262.8 +/- 129.5 and triglycerides 343.2 +/- 244.6 mg/dl. Interestingly, hypercholesterolemia (> 250 mg/dl) was found only in 44.8% of cases with nephrotic syndrome. Antinuclear antibody was demonstrated in 91.5%, anti-dDNA antibody in 64.4% and LE cells in 40.4% of cases. Renal biopsy was done in 45 patients and 30 cases (66.7%) were classified as diffuse proliferative nephritis (WHO type IV), 15.6% of type II, 6.7% each of type III and V, with the rest of type V plus IV (4.4%). Tubulointerstitial inflammation was found in 77.3% of cases. During the follow-up period (42 +/- 35.8 months), 6 patients died. The cause of death were uremia in 3, infection in 2, and cardiac failure in 1. By life-table analysis, the probabilities of survival for 1 and 5 years were 89.5 and 80.6%, respectively. In comparison between sexes, except for a higher amount of urinary protein excretion (4.5 +/- 3.1 vs 3.5 +/- 3.0 g/day, p < 0.05), there were no statistically significant differences in clinical and pathological parameters, and probability of survival.

Expression of c-erbB-2 oncoprotein in primary human tumors: an immunohistochemistry study.

An immunohistochemical study was performed with 130 primary malignant human tumors of breast (n = 55)..colon/rectum (n = 16), stomach (n = 19), esophagus (n = 14), lung (n = 15) and liver (n = 11) using the 21N c-erbB-2 specific monoclonal antibody to identify the tumors that over-expressed the c-erbB-2 oncoprotein. Positivity appeared as an intense brown granular staining located predominantly at the cell membrane. This occurred in 41.8% of breast carcinomas, 12.5% of colorectal adenocarcinomas. None of the gastric adenocarcinomas, squamous cell carcinomas of the esophagus, small cell lung carcinomas or hepatocellular carcinomas were positive for the oncoprotein. The result of this study suggests that over-expression of the c-erbB-2 oncoprotein is common in breast cancer and relatively rare in other malignancies examined.

Benign cystic teratoma of the parotid salivary gland: report of the first case in Thailand.

An extremely rare case of benign cystic teratoma of the parotid salivary gland is presented with a review of the literature. It was found in a 35-year-old Thai woman farmer who had had a history of a movable mass at the left parotid gland region for about 20 years. The microscopic examination revealed benign cystic teratoma of the parotid salivary gland. There is only one reported case in the literature, so, this is the second reported case.

Basaloid squamous carcinoma of the upper aerodigestive tract. Clinicopathologic and DNA flow cytometric analysis.

This report adds nine basaloid squamous carcinomas (BSC) of the upper aerodigestive tract to the 11 already recorded in the literature. It includes the first flow cytometric analysis of their DNA content and compares the clinical behavior of BSC with conventional squamous cell carcinoma (SCC). An uncommon variant of squamous carcinoma, BSC manifests a predilection for the hypopharynx and base of tongue of men in the sixth decade of life. Histologically, the carcinoma is characterized by a basaloid pattern often in an intimate association with focal squamous differentiation, comedonecrosis, and stromal hyalinization. It is an aggressive neoplasm: seven of the nine patients had metastases to cervical lymph nodes at time of initial surgery and three of the five deaths occurred within 24 months after primary surgery followed by radiotherapy. Its aggressiveness notwithstanding, the biologic course of BSC is similar to that of conventional SCC when clinical stage, site, and treatment are matched. Patients with aneuploid BSC had a better mean survival time (39.5 months) than those with diploid carcinomas (16.3 months). Surgery followed by radiotherapy appears to be the treatment of choice. Because of a high incidence of distant metastases, adjuvant chemotherapy may be warranted.

Fibrous dysplasia of jaws in Thais.

A clinico-radiologic-histologic review of fibrous dysplasia of the jaw in ninety-one Thai patients were studied. The lesions showed a slight predilection for females and for the maxilla. The mean age of patients was about 22 years. From available radiographic findings in 11 cases, 9 cases showed radiolucent lesions with ground glass appearance and 7 out of these cases had an ill defined border. Two out of 11 cases had mixed radiolucent radiopaque lesions and one of these had a well-defined border. Histologically, approximately half of the cases showed features of metaplastic woven bone in fibrous stroma. The peak incidences of woven bone and osteoid substance were between the ages of 11 and 20 years but for lamella bone only, the incidence was increased to the age of 31 and 40 years. The stromal component of each individual case showed variable amounts of fibroblasts, collagen fibers, vascularization and giant cells.

Lupus nephritis: clinicopathological study of 162 cases in Thailand.

One hundred and sixty two cases of lupus nephritis biopsied over three years in Thailand were studied. A pattern of clinical and histological renal disease very similar to that seen in the United States or Europe emerged. The predominant histological type was World Health Organisation class IV (diffuse proliferative; 58.6%). Patients with renal insufficiency (creatinine greater than or equal to 2 mg/100 ml) or hypertension at the time of biopsy had a considerably worse three year survival. Certain features such as sclerotic glomeruli, tubular atrophy, and an interstitial mononuclear cell infiltrate were significantly associated with a worse outcome (0.05 greater than p greater than 0.01), and patients who died with poor renal function had significantly higher chronicity scores than those in other groups (p less than 0.05). These findings emphasise the importance of chronic renal damage in the morbidity and mortality of patients with lupus nephritis.