PMC5438007_01
Photomicrograph of a characteristic erythrocyte cast found upon microscopy of the urinary sediment derived from the presented case (40x magnification).
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Figure1
Urinary sediment showed multiple, well-formed erythrocyte casts (Figure 1), less numerous granular casts, and a few broad, waxy casts along with 10 - 20 erythrocytes/hpf, 3 - 5 leukocytes/hpf, and no bacteria or crystals.
Panel of photomicrographs derived from the presented renal biopsy case. A: overview in periodic acid-Schiff (PAS) stain (100x magnification); B: detail of a glomerulus, PAS stain, (400x); C: detail of a glomerular Congo red stain (400x), note birefringence indicating presence of amyloid deposits; D: electron microscopic preparation showing amyloid fibrils (31,500x). Immunohistochemistry demonstrating presence of lambda (E), but not kappa (F) light chain deposits (400x); (images provided by Maike Buettner-Herold, M.D., Dept. of Renal Pathology, University of Erlangen, Germany).
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Figure2
The remainder had diffuse amorphous deposits in the mesangium and the capillary loops that were Congo red-positive with green birefringence under polarized light (Figure 2A, B, C). Electron microscopy confirmed the histopathological diagnosis of renal AL amyloidosis (Figure 2D).