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Balgradean M.,Carol Davila University of Medicine and Pharmacy | Cinteza E.,Clinic of Pediatrics | Mandache E.,Carol Davila Clinical Hospital for Nephrology
Romanian Journal of Morphology and Embryology | Year: 2013

A 15-year-old boy is admitted to the hospital for clinical signs that suggest a pulmonary-renal syndrome (fever, cough, hemopthoic expectoration, oliguria, gross hematuria). A crescentic pANCA positive glomerulonephritis was configured. However, dense subendothelial deposits were identified in electronic microscopy and immunofluorescence staining showed granular deposits of IgG and C3, kappa and lambda in the capillary loops. Although the treatment was strictly followed, after three years and three months of good clinical state, he manifested signs of kidney failure being transplanted. His case represents a specific pattern of rapidly progressive glomerulonephritis leading to kidney failure and emphasizes the importance of clinical attendance especially in a case of two associated glomerulopathies. Source


Penescu M.,Carol Davila Clinical Hospital for Nephrology | Mandache E.,Carol Davila Clinical Hospital for Nephrology
Romanian Journal of Morphology and Embryology | Year: 2010

The purpose of this work is to emphasize the value of kidney biopsy in patients with diabetes mellitus and clinical renal impairment. Diabetes is the leading cause of end stage renal disease because diabetic nephropathy develops in 30 to 40% of patients. Multiple genetic predisposing conditions are involved in the development or not of a diabetic nephropathy, therefore supporting the existence of several factors in the pathogenesis of this disease. These predisposing conditions may also favor different other types of glomerulonephritis which can occur independently or in parallel with a diabetic nephropathy. All these renal diseases have different treatments, and therefore they must be correctly identified and managed accordingly. The processing of the kidney biopsy samples requires a very careful and highly qualified management to differentiate precisely the nature of each condition. In addition to the mesangial classical lesions, recent biopsy studies provided evidence that podocytes are injured very early in the diabetic nephropathy. On the other hand, transgenic mice models provide a unique opportunity to investigate the natural course of the disease. The paper underlines the main laboratory techniques required for this activity, and the main structural arguments to perform a satisfactory differential diagnosis. Source


Mandache E.,Carol Davila Clinical Hospital for Nephrology | Penescu M.N.,Carol Davila Clinical Hospital for Nephrology
Romanian Journal of Morphology and Embryology | Year: 2012

It is currently considered that hump dense deposits developed during an acute poststreptococcal glomerulonephritis become finally dissolute by three hypothetical mechanisms: Loosing their electron density, internalization and processing by podocytes and by incorporation in the glomerular basal lamina (GBM). Analyzing ultrastructurally the association of polymorphonuclear leukocytes and hump deposits, we emphasized features endorsing the hypothesis that the immune complexes of dense deposits are discharged in the circulation under the leukocytes activity. The active polymorphonuclear cells are melting the GBM in the area of contact by complement activation and by the NAPlr bound plasmin. The reversed flow of immune complexes from humps towards the blood circulation leaves fading, wrinkled shaped humps, before total dissolution. Source


Mandache E.,Carol Davila Clinical Hospital for Nephrology | Penescu M.,Carol Davila Clinical Hospital for Nephrology
Romanian Journal of Morphology and Embryology | Year: 2012

The earliest glomerular lesion during the diabetic nephropathy is considered by many authors to be the so-called podocytopathy. Microalbuminuria is an early clinical marker of diabetic nephropathy that results from damages of the glomerular filtration barrier at the level of the highly differentiated podocytes. Thus, the diabetic podocytopathy includes cellular hypertrophy, foot process effacement, detachment from glomerular basement membrane (GBM), and apoptosis. The present paper is reviewing all these features and some additional ultrastructural transformations concerning the podocytes involved in the diabetic kidney disease. Source


Mandache E.,Carol Davila Clinical Hospital for Nephrology | Penescu M.,Carol Davila Clinical Hospital for Nephrology
Romanian Journal of Morphology and Embryology | Year: 2011

In the last decade, it has been accepted the formation of tertiary lymphoid organs in the renal parenchyma during inflammatory conditions. These organized cellular aggregates contain B- and T-lymphocytes, dendritic cells, surrounded by neo-lymphatic vessels. They have been described in renal allografts, acute and chronic interstitial nephritis, IgA and membranous nephropathies. The functional characteristics of these lymphoid nodules remained still under consideration. After investigating the renal biopsies of 268 patients with primary and secondary nephropathies, we have selected 20 cases showing lymphoid-like cellular aggregates located just beneath the renal capsule and having close contacts with this kidney envelope. All of these cases also showed an associated medium sized lymphatic vessel. The ultrastructure of these nodules proved to contain more or less the same cellular composition: lymphocytes, dendritic cells, seldom plasma cells and macrophages. We consider these particular subcapsular lymphoid-like nodules to be tertiary lymphatic structures in close association with the perirenal lymphatics, and the first to develop in any type of inflammatory and autoimmune renal condition. Source

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