Introduction: Immunofluorescence (IF) microscopy is an essential tool for the analysis of glomerular diseases. In this study, we studied the significance of the IF technique together with light microscopy (LM) and clinical details in the diagnosis of different types of diffuse proliferative glomerulonephritis (GN). We intended to evaluate the spectrum of Diffuse Proliferative Glomerulonephritis (DPGN) in our institute. Materials and Methods: We evaluated a total of 95 kidney biopsies received in the past 10 years. All biopsies were scrutinized by LM and IF techniques. Clinical details were documented in a predesigned form. Results: The predominant clinical presentation in this study was nephrotic syndrome (49.4%) followed by systemic lupus erythromatosus with suspected renal involvement (24.2%). On microscopy, lupus nephritis (LN) was the most common DPGN in the study (35.7%), followed by immunoglobulin (Ig) A nephropathy (25.2%) and postinfectious GN (PIGN) (16.8%). The majority of patients were in the <30 years age group (72.6%), with the average age of patients being 24.4 years. The dominant deposit on IF in LN was C3 and IgG (100%). A high deposit of IgA (100%) in IgA nephropathy and of IgG and C3 (100%) in membranoproliferative GN was seen. PIGN showed dominant positive staining of IgG (92.8%). Conclusion: The predominant clinical presentation was of nephrotic syndrome and on LM LN was the most commonly diagnosed DPGN in this study. Direct IF is vital for classifying DPGN, followed by electron microscopy, which is an essential tool. This article describes a rational evaluation of kidney biopsies with DPGN pattern on LM in a way that guides toward the logical assessment to reach the diagnosis. Using the IF technique and comparing it with LM and clinical details, we evaluated the spectrum DPGN in our center.
Amyloidosis is a complex multisystem disorder characterized by deposition of an aberrant protein in tissues and results in disruption of the normal organ function. Localized amyloidosis is a rare disorder. It commonly affects the head-and-neck region, and only 4% of these lesions are encountered in the orbital region. Hence, conjunctival amyloidosis is a very rare entity. It is thought to be a manifestation of local immunologic disorders. Amyloidosis of conjunctiva is more often localized with no other systemic features. Here, we present two cases of unilateral conjunctival amyloidosis, one with extensive calcification. Conjunctival amyloidosis must be considered in the differential diagnosis of conjunctival neoplasms. Histopathological examination and apple-green birefringence on polarized microscopy with Congo red stain remain the gold standard for diagnosing this entity.
Background: Chronic lymphocytic leukemia (CLL) is prognosticated using the Rai and the Binet's staging. In the past few years, new parameters have been considered for prognostication. One such marker that has been a subject of speculation and found useful by some western studies is zeta-associated protein 70 (ZAP-70). Aim: To investigate the prevalence of ZAP-70 and find out its association with other prognostic markers like Rai and Binet's stage and CD38 in Indian CLL patients. Materials and Methods: Twenty-nine newly diagnosed cases of CLL were selected over 1 year. Immunophenotyping was done and expression of CD38 and ZAP-70 was evaluated on gated CLL cells. Statistical Analysis: Qualitative data were expressed as frequency and percentage. Differences between groups were evaluated using Student's t-test for quantitative data and Chi-square test/Fisher's exact t-test for qualitative variables. A P value less than 0.05 was considered significant. Results and Conclusion: We found a lower prevalence rate of ZAP-70 (2/29, 6.89%) with no association with any of the conventional poor prognostic factors. A large number of our CLL patients fall into the good prognostic group (22/29, ZAP 70−/CD38−) with a least number in the poor prognostic group (2/29, ZAP-70 + CD38+). Also, no association was found between ZAP-70 and CD38. The findings of the present study suggest that the majority of CLL patients in India have a good prognosis, may not require treatment, and have good overall survival. Geographical variations, genetic makeup, and natural history of the CLL could be the cause of such differences from western literature.
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