American Journal of Kidney Diseases
Volume 56, Issue 1 , Pages A35-A40 , July 2010

Quiz Page July 2010: Multiple Lung Nodules With Worsening Kidney Function

  • Hitomi Tanaka, MD

      Affiliations

    • Nephrology Unit, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
    • ,
  • Takuma Fujii, MD

      Affiliations

    • Nephrology Unit, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
    • ,
  • Takashi Kusaura, MD

      Affiliations

    • Nephrology Unit, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
    • ,
  • Akiko Kobayashi, MD

      Affiliations

    • Respiratory Unit, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
    • ,
  • Hisashi Oshiro, MD, PhD

      Affiliations

    • Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
    • ,
  • Takeshi Sasaki, MD, PhD

      Affiliations

    • Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
    • ,
  • Yutaka Yamaguchi, MD, PhD

      Affiliations

    • Department of Pathology, Kashiwa Hospital, Jikei University, Kashiwa, Japan
    • ,
  • Kiyotaka Nagahama, MD

      Affiliations

    • Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
    • Corresponding Author InformationAddress correspondence to Kiyotaka Nagahama, MD, Department of Pathology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan

  • Image Result

    Chest computed tomographic (CT) scans and gallium scintigraphic images of the patient. (A) Chest CT scan shows multiple ill-defined consolidations with spiculation in bilateral lungs. (B) Gallium scin

    Chest computed tomographic (CT) scans and gallium scintigraphic images of the patient. (A) Chest CT scan shows multiple ill-defined consolidations with spiculation in bilateral lungs. (B) Gallium scintigraphy shows abnormal gallium accumulation in the hilar lymph nodes, lungs, and kidneys (arrows).

  • Image Result
    Microscopic analysis of biopsy specimens from the lung and kidney of the patient. Light microscopy of (A, B) transbronchial lung and (C-F) kidney biopsy specimens (A-D, hematoxylin and eosin stain; E,

    Microscopic analysis of biopsy specimens from the lung and kidney of the patient. Light microscopy of (A, B) transbronchial lung and (C-F) kidney biopsy specimens (A-D, hematoxylin and eosin stain; E, methenamine-silver stain; F, immunofluoresent immunoglobulin G staining). (G, H) Electron micrographs of the kidney biopsy specimen.

  • Image Result
    (A) Immunostaining showed that most immunoglobulin G (IgG)-bearing cells are (B) positive for IgG4.

    (A) Immunostaining showed that most immunoglobulin G (IgG)-bearing cells are (B) positive for IgG4.

  • Image Result
    Consolidation lesions are diminished and inconspicuous in a follow-up chest computed tomographic scan for the patient after 3 months of prednisone therapy.

    Consolidation lesions are diminished and inconspicuous in a follow-up chest computed tomographic scan for the patient after 3 months of prednisone therapy.

 Support: This study was supported by a grant-in-aid from the Ministry of Education, Culture, Sports, Science and Technology, Japan (no. 20790993 to H.O. and no. 21790817 to K.N.).

 Financial Disclosure: None.

PII: S0272-6386(09)01262-1

doi: 10.1053/j.ajkd.2009.09.013

American Journal of Kidney Diseases
Volume 56, Issue 1 , Pages A35-A40 , July 2010

Article Tools

* Image Usage & Resolution