Ultrastructural Pathology, 2015; 39(2): 152 ;! Informa Healthcare USA, Inc. ISSN: 0191-3123 print / 1521-0758 online DOI: 10.3109/01913123.2014.966937
LETTER TO THE EDITOR
Cryoglobulinemic Nephropathy Sai Tin Sim, MD1 and Viroj Wiwanitkit, MD2 1
Medical Science, Medical Center, Shantou, China and 2Tropical Medicine, Hainan Medical University, China
REFERENCES
The report on ‘‘Cryoglobulinemic nephropathy (CN)’’ is an interesting topic [1]. Ojemakinde et al. concluded that ‘‘Because the immunomorphologic manifestations of CN are so varied, confirmation of a suspected diagnosis of CN or making a diagnosis in a less than a typical immunomorphologic setting required careful ultrastructural evaluation [1]’’. In fact, the diagnosis of cryoglobulinemic nephropathy is a challenge in nephrology. In general, the diagnosis uses the histopathological test. It is no doubt that the electron microscopic finding is superior to light microscopic finding in determining the deposits [2,3]. However, the important concern is on the limitation of the electron microscope to differentiate the deposits seen in nephropathy. There are many diseases with similar deposits to CN such as amyloidosis and immunotactoid glomerulopathy [4]. The sole use of electron microscope is not enough. It usually requires additional analysis such as immunological test, histological study or proteomic analysis for differential diagnosis [4,5].
1. Ojemakinde K, Turbat-Herrera EA, Zeng X, et al. The many faces of cryoglobulinemic nephropathy: A clinicopathologic study of 47 cases with emphasis on the value of electron microscopy. Ultrastruct Pathol 2014: 1-10. [Epub ahead of print]. 2. Faraggiana T, Parolini C, Previato G, Lupo A. Light and electron microscopic findings in five cases of cryoglobulinemic glomerulonephritis. Virchows Arch A Pathol Anat Histol 1979;384: 29–44. 3. Monga G, Mazzucco G, Casanova S, et al. Ultrastructural glomerular findings in cryoglobulinemic glomerulonephritis. Appl Pathol 1987;5: 108–15. 4. Sethi S, Theis JD, Vrana JA, et al. Laser microdissection and proteomic analysis of amyloidosis, cryoglobulinemic GN, fibrillary GN, and immunotactoid glomerulopathy. Clin J Am Soc Nephrol 2013;8: 915–21. 5. Hirahashi J, Kuramochi S, Konishi K, et al. Glomerulonephritis with microtubular deposits associated with cryoglobulinemia and chronic active hepatitis. Pathol Int 2002;52: 483–7.
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
Received 7 September 2014; Accepted 15 September 2014; Published online 27 October 2014 Correspondence: Sai Tin Sim, MD, Medical Science, Medical Center, Shantou, China. E-mail: [email protected]
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Copyright of Ultrastructural Pathology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
LETTER TO THE EDITOR
Cryoglobulinemic Nephropathy Sai Tin Sim, MD1 and Viroj Wiwanitkit, MD2 1
Medical Science, Medical Center, Shantou, China and 2Tropical Medicine, Hainan Medical University, China
REFERENCES
The report on ‘‘Cryoglobulinemic nephropathy (CN)’’ is an interesting topic [1]. Ojemakinde et al. concluded that ‘‘Because the immunomorphologic manifestations of CN are so varied, confirmation of a suspected diagnosis of CN or making a diagnosis in a less than a typical immunomorphologic setting required careful ultrastructural evaluation [1]’’. In fact, the diagnosis of cryoglobulinemic nephropathy is a challenge in nephrology. In general, the diagnosis uses the histopathological test. It is no doubt that the electron microscopic finding is superior to light microscopic finding in determining the deposits [2,3]. However, the important concern is on the limitation of the electron microscope to differentiate the deposits seen in nephropathy. There are many diseases with similar deposits to CN such as amyloidosis and immunotactoid glomerulopathy [4]. The sole use of electron microscope is not enough. It usually requires additional analysis such as immunological test, histological study or proteomic analysis for differential diagnosis [4,5].
1. Ojemakinde K, Turbat-Herrera EA, Zeng X, et al. The many faces of cryoglobulinemic nephropathy: A clinicopathologic study of 47 cases with emphasis on the value of electron microscopy. Ultrastruct Pathol 2014: 1-10. [Epub ahead of print]. 2. Faraggiana T, Parolini C, Previato G, Lupo A. Light and electron microscopic findings in five cases of cryoglobulinemic glomerulonephritis. Virchows Arch A Pathol Anat Histol 1979;384: 29–44. 3. Monga G, Mazzucco G, Casanova S, et al. Ultrastructural glomerular findings in cryoglobulinemic glomerulonephritis. Appl Pathol 1987;5: 108–15. 4. Sethi S, Theis JD, Vrana JA, et al. Laser microdissection and proteomic analysis of amyloidosis, cryoglobulinemic GN, fibrillary GN, and immunotactoid glomerulopathy. Clin J Am Soc Nephrol 2013;8: 915–21. 5. Hirahashi J, Kuramochi S, Konishi K, et al. Glomerulonephritis with microtubular deposits associated with cryoglobulinemia and chronic active hepatitis. Pathol Int 2002;52: 483–7.
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
Received 7 September 2014; Accepted 15 September 2014; Published online 27 October 2014 Correspondence: Sai Tin Sim, MD, Medical Science, Medical Center, Shantou, China. E-mail: [email protected]
152
Copyright of Ultrastructural Pathology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
