Nephrotic Syndrome

Septal amyloidosis shows characteristic apple green birefringence of amyloid on Congo red stain.

<bold>Figure 31.19</bold> Hemodynamics of amyloidosis, a restrictive cardiomyopathy. The elevated right atrial pressure, Kussmaul sign, and prominent Y descents <bold>(A)</bold> as well as the dip and plateau in the right ventricular tracing <bold>(B)</bold> are indicative of severe right ventricular dysfunction and not constriction. Prominent V waves <bold>(C)</bold> are present in the wedge tracing despite the lack of mitral regurgitation and reflect the volume overload in the stiff atrium, characteristic of amy...

<bold>Figure 31.19</bold> Hemodynamics of amyloidosis, a restrictive cardiomyopathy. The elevated right atrial pressure, Kussmaul sign, and prominent Y descents <bold>(A)</bold> as well as the dip and plateau in the right ventricular tracing <bold>(B)</bold> are indicative of severe right ventricular dysfunction and not constriction. Prominent V waves <bold>(C)</bold> are present in the wedge tracing despite the lack of mitral regurgitation and reflect the volume overload in the stiff atrium, characteristic of amy...

<bold>Figure 31.19</bold> Hemodynamics of amyloidosis, a restrictive cardiomyopathy. The elevated right atrial pressure, Kussmaul sign, and prominent Y descents <bold>(A)</bold> as well as the dip and plateau in the right ventricular tracing <bold>(B)</bold> are indicative of severe right ventricular dysfunction and not constriction. Prominent V waves <bold>(C)</bold> are present in the wedge tracing despite the lack of mitral regurgitation and reflect the volume overload in the stiff atrium, characteristic of amy...

<bold>Figure 31.19</bold> Hemodynamics of amyloidosis, a restrictive cardiomyopathy. The elevated right atrial pressure, Kussmaul sign, and prominent Y descents <bold>(A)</bold> as well as the dip and plateau in the right ventricular tracing <bold>(B)</bold> are indicative of severe right ventricular dysfunction and not constriction. Prominent V waves <bold>(C)</bold> are present in the wedge tracing despite the lack of mitral regurgitation and reflect the volume overload in the stiff atrium, characteristic of amy...

<bold>Figure 31.19</bold> Hemodynamics of amyloidosis, a restrictive cardiomyopathy. The elevated right atrial pressure, Kussmaul sign, and prominent Y descents <bold>(A)</bold> as well as the dip and plateau in the right ventricular tracing <bold>(B)</bold> are indicative of severe right ventricular dysfunction and not constriction. Prominent V waves <bold>(C)</bold> are present in the wedge tracing despite the lack of mitral regurgitation and reflect the volume overload in the stiff atrium, characteristic of amy...

<bold>FIGURE 67-3</bold> <bold>Immune complex glomerulonephritis. A.</bold> Immunofluorescence staining of the glomerulus stained with antibodies directed against C3 showing deposits in the capillary walls and the mesangium. <bold>B.</bold> Electron micrograph of a glomerular tuft revealing electron-dense immune complex deposits in the mesangium (single arrow) and subendothelial capillary space (double arrow). The basement membrane splits to surround the subendothelial d...

<bold>FIG. 93.1.</bold> A: Electron micrograph of amyloid surrounding a cardiac myocyte (×20, 125). B: High-magnification image showing typical fi illar nature of amyloid deposit (×68,125).

<bold>FIG. 93.1.</bold> A: Electron micrograph of amyloid surrounding a cardiac myocyte (×20, 125). B: High-magnification image showing typical fi illar nature of amyloid deposit (×68,125).

<bold>FIG. 93.16.</bold> Two-dimensional echocardiogram for the same subject as depicted in Fig. 93.6. Classic features of amyloid cardiomyopathy are thickened intraventricular septum <italic>(IVS)</bold>, left ventricular posterior wall <italic>(PW)</bold>, and enlarged left atrium <italic>(LA)</bold>.

<bold>FIG. 93.17.</bold> Electrocardiogram of a patient with amyloid cardiomyopathy. Low voltage is a prominent feature, and the standard, but erroneous, interpretation as "septal infarct, age indeterminate" is common.

<bold>Figure 31.19</bold> Hemodynamics of amyloidosis, a restrictive cardiomyopathy. The elevated right atrial pressure, Kussmaul sign, and prominent Y descents <bold>(A)</bold> as well as the dip and plateau in the right ventricular tracing <bold>(B)</bold> are indicative of severe right ventricular dysfunction and not constriction. Prominent V waves <bold>(C)</bold> are present in the wedge tracing despite the lack of mitral regurgitation and reflect the volume overload in the stiff atrium, characteristic of amy...

<bold>Figure 31.20</bold> Electrocardiogram of a patient with amyloid. Classic findings include low limb lead voltage but preserved precordial voltage, nonspecific ST changes, P wave prominence, and pseudoinfarct pattern with precordial Q waves.

<bold>Figure 31.22</bold> Endomyocardial biopsy of patient with amyloid. A. Even without congo red staining, amyloid is suggested by separation of myofibrils and infiltration of blood vessels by pink amorphous proteinaceous material. Hypertrophy notably absent as well. <bold>B.</bold> At autopsy, left atrial walls appear leathery and waxy, consistent with endocardial deposition of amyloid protein.

Hemidialysis

Homeless diabetic man with painful foot showing gangrene and dystrophic nails

35 year-old with discoid lupus

FIGURE 3-2. Peritoneal dialysis, in which the dialysate is infused into the peritoneal cavity by gravity. (Reprinted with permission from Rosdahl, Kowalski. Textbook of Basic Nursing. 8th Ed. Philadelphia: Lippincott Williams &amp; Wilkins, 2003:1208.)

Fig 13-7. Peritoneal dialysis. A semipermeable membrane richly supplied with small blood vessels lines the peritoneal cavity. With dialysate dwelling in the peritoneal cavity, waste products diffuse from the network of blood vessels into the dialysate.

Parasternal long (A) and apical four-chamber (B) and mitral inflow (C) in advanced cardiac amyloidosis. Note that the left ventricular size is normal with markedly thickened ventricular walls and has its characteristic granular sparkling appearance. DT, deceleration time; LA, left atrium; LV, left ventricle; PE, pericardial effusion; PL EFF, pleural effusion; pm, papillary muscle; RA, right atrium; RV, right ventricle.

<bold><italic>Figure 14.60.</bold></bold> Pretibial diabetic skin changes: necrobiosis lipoidica diabeticorum.

FIG. 11 Diabetic patient with acute spontaneous onset of low back pain and fever. <bold>A,B:</bold> Dramatic elements of two-level spondylodiscitis, L3-5, with secondary communicating psoas abscess component.

Hemodialysis.

<bold>Figure 11.93. Neuropathic (Charcot) joints in two diabetic patients. A.</bold> Radiographs of both feet show bilateral neuropathic joints at the first metatarsophalangeal joints (<italic>arrows</bold>). On the left there is periarticular osteopenia, indicating superimposed infection. Frontal <bold>(B)</bold> and lateral <bold>(C)</bold> knee radiographs of another patient show disintegration of the knee joint with considerable bony debris (" bag of bones") and a large joint effusion. In the past, involvement o...

Necrobiosis lipoidica diabeticorum. Atrophic patch present x 6 mo.

Hemodialysis, external arteriovenous shunt. Illustration of the medial side of the right arm with an external arteriovenous shunt uses in hemodialysis.

<bold><italic>Figure 19-11</bold> Crescentic glomerulonephritis.</bold> Crescent of epithelial cells proliferates along the parietal rim of the glomerular space and obliterates the glomerulus. Crescentic glomerulonephritis is an anatomic finding in progressively worsening glomerulonephritis of many types. Reprinted with permission from Rubin E. Pathology. 4th ed. Philadelphia. Lippincott Williams and Wilkins‚ 2005.

<bold><italic>Figure 19-12</bold> Membranous glomerulonephritis (light microscopy).</bold> Basement membrane is thickened by immunoglobulin deposits.

<bold>FIGURE 11-44. Cardiac amyloidosis.</bold><bold>A.</bold> A section of myocardium stained with Congo red shows interstitial, pink-staining deposits of amyloid. <bold>B.</bold> Under polarized light, the same section displays the characteristic green birefringence of amyloid fibrils.

Graft for hemodialysis angio access - A self-sealing polytetrafluoroethylene (PTFE) silicone graft is used as an internal bridge (AV fistula) for vascular access in patients requiring maintenance hemodialysis. In the figure the graft bridges the brachial artery to the axillary vein

Hemodialysis, internal arteriovenous fistula. Illustration of the medial side of the right arm with an internal arteriovenous fistula used in hemodialysis.

Continuous ambulatory peritoneal dialysis: Step 1 After applying a mask, a bag of dialysate is attached to the tube entering the patient's abdominal area so that the fluid flows into the peritoneal cavity. The mask is removed when this step is completed.