December 2017

SIGNALMENT:  (JPC #2237297) Tissue from a dog.

HISTORY:  None provided.

CBC               Range            Chemistry                 Range            Urinalysis

WBC 23.1      (5-14.1)          Phos 12.7                  (2.9-5.3)         S.G.                1.020

Segs 84%                              BUN 159                    (8-28)              pH                   6.5

Lymphs 6 %                          AST    186                 (13-15)           Protein           952 mg/dl

Monos 7%                           Creatinine 6.7           (0.5-1.7)         Creatinine     73 mg/dl

Bands 1%                            Cholesterol 340        (135-278)       Blood              3+

Eos 2%                                T.P.     5.1                   (5.4-7.5)        

                                          Alb      2.1                   (2.3-3.1)

HISTOPATHOLOGIC DESCRIPTION:  Kidney:  Diffusely, glomeruli vary in size, and are either expanded, measuring up to 400 um in diameter, or are atrophied with mild expansion of the urininferous space (glomerulocystic atrophy). Multifocally glomeruli contain one or more of the following changes: hypercellularity with the presence of few neutrophils and scattered eosinophilic and karyorrhectic cellular debris (necrosis); thickening of glomerular capillary loops  up to three times normal;  expansion of glomerular mesangium  by variable amounts of eosinophilic fibrillar material and thickening of glomerular basement membranes.  Other glomerular changes include: hypertrophy and hyperplasia of parietal and visceral epithelium; adhesions between glomerular tufts and Bowman"s capsule (synechiae); expansion of the uriniferous space by hypereosinophilic homogenous material (proteinaceous fluid) and/or fibrin (glomerular crescent); and  periglomerular fibrosis and mineralization.  Multifocally, tubules are ectatic, up to 150 um in diameter, and have one or more of the following changes: expansion of the lumen by eosinophilic proteinaceous fluid; attenuation of epithelium; necrosis characterized by shrunken hypereosinophilic epithelial cells with pyknotic nuclei; hypertrophied epithelial cells with vacuolated cytoplasm (degeneration); regeneration characterized byepithelium that is  piled up with increased cytoplasmic basophilia; filling of tubule lumina by sloughed epithelial cells admixed with cellular debris.  Multifocally and extensively, tubule epithelial cell cytoplasm contains brown globular pigment (hemosiderin or lipofuscin).  Multifocally, within the cortical interstitium, there are many lymphocytes and plasma cells that often surround glomeruli and vessels. 

MORPHOLOGIC DIAGNOSIS:  Kidney:  Glomerulonephritis, membranoproliferative, chronic, global, diffuse, moderate, with tubular degeneration, necrosis, regeneration, and lymphoplasmacytic interstitial nephritis, breed unspecified, canine.

ETIOLOGIC DIAGNOSIS:  Borrelial glomerulonephritis

CAUSE:  Borrelia burgdorferi

CONDITION:  Lyme disease, Lyme borreliosis, Lyme nephritis







Classic triad of lesions:

  1. Diffuse membranoproliferative glomerulonephritis with periglomerular fibrosis and glomerular synechiae to Bowman"s capsule; variable crescent formation (fibrin, inflammatory cells within uriniferous space)
  2. Multifocal tubular necrosis and regeneration, cortical tubular dilation, and luminal protein casts
  3. Lymphoplasmacytic interstitial nephritis






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