Table 2 Kidney biopsy findings chart
SL No | Primary Author | Light microscopy | IF | EM | ||
|---|---|---|---|---|---|---|
Glomerular changes | Tubulointerstitial changes | Vascular changes | ||||
1 | Chugh et al. 1975, [8] | ACN in n = 3 (50%) of the cases. Surviving glomeruli in areas of necrosis showed fibrin thrombi and some proliferation of mesangial cells. | ATN in n = 3 (50%) of the cases | Not mentioned specifically | NR | NR |
2 | Basu et al., 1977, [9] | ACN in 2 (5.4%) of the cases. Glomerular tuft necrosis n = 5 (13.4%),Isolated Glomerular thrombosis n = 7 (19%) | ATN in 32 (86.4%) cases. Peritubular infiltration of inflammatory cells n = 6 (16.2%) Medullary haemorrhagen = 14 (27%) | Vessel wall necrosis n = 5 (13.4%) Fibrin thrombi in arteriole n = 2 (5.4%) | NR | NR |
3 | Shastry et al., 1977 [10] | ACN in 3 (15.7%) of the cases. Focal mesangial hypercellularity in n = 6 (32%). | ATN in 12 (63.2%) of cases, Interstitial haemorrhage n = 3 (15.7%). Presence of hyaline, granular and heme cast. Vacuolation and regeneration. Intertitial fibrosis in 1 case Interstitial oedema (10.5%) Interstitial inflammation n = 10 (52.6%) | Not mentioned specifically | NR | NR |
4 | Sarangi et al., 1980, [11] | ACN in one case. Aneurysmal capillary dilatation and inflammatory cell infiltration were seen in glomerulus | Acute tubular injury n = 3 (13.6%), Acute tubular necrosis n = 6 (27.2%), Presence of interstitial haemorrhage oedema (5 cases) and RBC tubular cast. | Not mentioned specifically | NR | NR |
5 | Date et al., 1982, [12] | Glomeruli was normal except for focal mesangial expansion and focal prominence of parietal epithelium. One case had necrosis of cortical tissue | ATN n = 9 ( 100%) .The interstitium was expanded and infiltrated by mononuclear cells and scattered eosinophils predominantly at the cortico-medullary junction. | No abnormality | NR | Glomeruli: Swollen bowman’s capsule epithelium containing numerous organelles. The visceral epithelium revealed microvilli, patchy foot process fusion and intracytoplasmic lipid vacuoles. Glomerular capillaries had irregular thickening and wrinkling of glomerular basement membrane. Mesangial expansion was present in all biospies. Subendothelial electron dense deposits were seen in one case and one case had features of ACN. Blood vessels: Swollen endothelial cells containing numerous vacuoles and a dilated smooth endoplasmic reticulum. Interstitium: Oedematus intertubular tissue and infiltration of inflammatory cells including eosinophils, 6mast cells, plasma cells and lymphocytes and some macrophages and basophils. |
6 | Chugh et al., 1984, [13] | ACN n = 10 (28.5%). Superficial cortical glomeruli were more severely congested compared to deep juxtamedullary glomeruli. Hilar glomerular capillaries were partly filled with recent thrombus. | ATN n = 23 (65.7%). PCT showed shrunken, pyknotic nuclei or no stainable nuclei with cytoplasmic cloudy swelling and considerable tubulorrhexis. Distal convolutions were collapsed. Collecting ducts contained brown heme casts or pigments. | The large intrarenal arteries were deeply congested. The intertubular capillaries were crowded with neutrophils. In some cases venules and veins were congested with inflammatory cells. | NR | NR |
7 | Date et al., 1986 [14] | ACN n = 3 ( 20%) | ATN n = 12 (80%) | NR | Not done | Done in 7 (46.6%) biopsies. Biopsies revealed platelet and fibrin clusters in glomeruli and small calibre vessels |
8 | Acharya et al., 1989 [15] | ACN in 7 (24.1) cases. Ballooning of glomerular capillaries (n = 10), swollen endothelial cells (n = 10), splitting of basement membrane (n = 19). Mesangial cell proliferation (n = 5). Proliferative glomerular changes in 5 cases. | ATN in 10 (40% ) cases with evidence of tubular degeneration in 17% cases (42.5%) | Vasculitis like changes in vesselsN = 3 (7%) cases. Fibrin thrombi in capillaries, n = 6(24.2% )cases. | Not done | Not done |
9 | Chugh et al., 1989 [16] | Patchy ACN in 4 cases (9%) and diffuse cortical necrosis in 8 patients (18%). | ATN was present in 32 (73%) of cases, AIN in 3 patients (6.8%). | Necrotizing arteritis of the interlobular arteries along with thrombophlebitis of the arcuate vein and its tributaries in 2 cases. | Dense deposits of C3 were seen in the walls of afferent and efferent arterioles in cases of necrotizing arteritis. | Not done |
10 | Mittal et al., 1994 [17] | ACN in 25 (60.9%) cases. Focal proliferation of mesangial cell n = 5 (12.1%). Mild mesangial proliferation n = 22 (53.6%). Mesangiolysis n = 7 (17.7%) Ballooning of glomerular capillaries n = 13 (31.7%), swollen endothelial cells n = 16 (39%), splitting of basement membrane n = 11 (26.8%). Capillary thrombi n = 5 (12.1%). | Tubular necrosis n = 5 (12.1%), Tubular regeneration n = 2 (4.8%). Pyelonephritis complicating tubular necrosis and one autopsied case revealed abscesses. Haemorrhagic interstitial nephritis with haemorrhage in subcapsular area in case. | Other than in cases of ACN. Not mentioned specifically | Done in 7 cases [17] IgG (weak +):2 cases IgM (weak +):1 case C3 (+):2 cases in mesangial area. Presence of fibrin in mesangial area: 1 case | Not done |
11 | Chugh et al., 1994 [18] | ACN in all 16 patients | NR | NR | NR | NR |
12 | Vijeth et al. [19] | NR | ATN in 3 (100%) cases | NR | NR | NR |
13 | Golay et al., 2012 [20] | Normal glomeruli | ATN in 8 (21.5% ) and AIN in 5 (11.9%) cases. Extensive interstitial inflammation was observed in all the AIN cases, with pre-dominantly lymphocytic infiltration, in one case where eosinophils were predominant. | Normal Blood vessels | No IF deposits | NR |
14 | Waikhom et al., 2012 [21] | ACN in 3 patients (30%) | ATN in 6 patients (60%). AIN in1 case | Not specifically mentioned | NR | NR |
15 | Waikhom et al., 2013 [22] | ACN in one case. | ATN in 3 patients.(60%).AIN in1 case | Not specifically mentioned | NR | NR |
16 | Golay et al., 2013 [23] | ACN in one (25% ) case | ATN in 3 (75% ) patients | Not specifically mentioned | NR | NR |
17 | Mukhopadhyay et al., 2016 [24] | ACN in one out of 3 patients | ATN in 2 out of 3 patients. (66.6%) | NR | NR | NR |
18 | Vikrant et al., 2017 [25] | Patchy ACN in one case. | ATN in 20 (91%) cases. In 9 (40.9%) ATN was associated with mild to moderate AIN. One (4.5%) patient only had moderate AIN | Not specifically mentioned | Findings not specifically mentioned | NR |
19 | Priyamvada et al., 2016 [26] | Diffuse mesangial proliferation; in 1(20% )out of 5 case. Rest were normal | ATN in 4 cases (57.1%). AIN in 5 out of 7 cases (71.4%). Lymphocyte-predominant infiltration in all patients. 4 patients (57.1%). had admixture of other cell types including eosinophils, neutrophils, and plasma cells. Neutrophil cast in was seen 1 patient. | Not specifically mentioned | Weak 1 + C1q deposits in mesangium of 1 patient | NR |
20 | Dinesh kumar et al., 2018 [27] | Not specifically mentioned | AIN was reported in 20 ( 23.5%) out of 85 biopsies. Marked infiltration of eosinophils and lymphocytes was seen along with tubular injury. | Not specifically mentioned | Negative in all patients | NR |
21 | Shaktirajan et al., 2018 [28] | None of the patients had significant glomerulosclerosis or any other specific glomerular abnormality | Snake bite envenomation was present in 10 out of 46 patient of pigment induced nephropathy. All renal biopsies revealed ATN with pigment casts in the tubules. No interstitial fibrosis or tubular atrophy were noted | Not specifically mentioned | NR | NR |
22 | Priyamvada et al. 2020 [29] | 1 out of 2 patients had features of chronic TMA | Not specifically mentioned | Not specifically mentioned | NR | NR |
23 | Rao et al., 2019 [30] | Biospsy of both patient was suggestive of ACN with fibrin thrombi in glomerular capillary lumen and arterioles. TMA was present in both cases. | One biopsy showed evidence of AIN along with TMA | Fibrin thrombi was present in in glomerular capillary lumen and arterioles. | NR | NR |
24 | Islam et al., 2020 [31] | ACN in n = 8 (12.5%) cases. | ATN in n = 25 (39.1) %. cases | NR | NR | NR |
25 | Kumar M et al., 2022 [32] | • 5 (12% ) out of 41 had ACN. • 4 (9.7 )out of 41 had TMA • One patient had TMA with renal cortical necrosis | • ATN in n = 18 (44%) cases. • N = 5 (12% ) biopsies showed pigmented casts • AIN was reported in 9 ( 22%). • N = 5 (12% )cases had ATN with AIN | NR | NR | NR |
26 | Ariga et al., 2021 [33] | NR | Out of 6, n = 2 (50%) were ATN and n = 4 (66.6% ) were AIN | NR | NR | NR |
27 | Acharya et al., 2023 [34] | • ACN in n = 7 (23%) | • AIN was reported in n = 6 ( 22%). • ATN in n = 18 (59.6)% cases. | NR | NR | NR |
28 | Prema et al. [35] | NR | • All 16 snake bite patients had ATN alongside hemoglobulin cast nephropathy. • Hemoglobin casts were seen present in the PCT. The casts were bright red to brown on hematoxylin and eosin stain weakly PAS positive, argyrophilic on Jones methenamine silver stain, and granular to globular in texture. Hemoglobin IHC was positive on the pigment casts. Two patients showed myoglobin immunostain positivity. | NR | NR | NR |