✍ Scribed by Townsend, V. R.; Felgenhauer, B. E.
No coin nor oath required. For personal study only.
ImDortance of morDholoaic markers of locallv increased interferon levels in the ultrastructural evaluation of renal biomies. Tubuloreticular inclusions (TRI) and cylindrical confronting cisternae (CCC) are structures which can be identified ultrastructurally and have been associated with locally increased interferon levels in tissues. TRI have long been recognized to occur in a variety of conditions, particularly autoimmune diseases. CCC are recognized in a limited number of conditions. The combination of TRI and CCC have only been detected in a few disease states including human immunodeficiency virus infection, multiple sclerosis, adult T-cell leukemia, systemic lupus erythematosus, some neoplasms, and patients undergoing interferon treatment. As such, these structures can be useful in narrowing a differential diagnosis.
A 36 year old man underwent splenectomy for the treatment of hereditary spherocytosis. Postoperatively, he rapidly developed renal failure, and he underwent renal biopsy to evaluate this problem. By light microscopy, the kidney exhibited numerous glomerular crescents, and the category of rapidly progressive glomerulonephritis seemed likely. Ultrastructurally, however, deposits were seen, and both TRI and CCC were identified. These findings suggested the alternative possibility of lupus nephritis. Additional laboratory study in conjunction with his clinical findings confirmed this diagnosis. In this case, the identification of TRI and CCC was important for the proper categorization and treatment of this patient's disease.
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