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Renal Thrombotic Microangiopathy, Podocytopathy, and Chylous Ascites: A Hard-Nosed Diagnosis
Blaithin A. McMahon, MD, PhD, Robert A. Moran, MD, Christopher J. Sperati, MD, MHS, Serena Bagnasco, MD, Tessa Novick, MD, Mohamed G. Atta, MD, MPH The American Journal of Medicine Volume 129, Issue 10, Pages e227-e231 (October 2016) DOI: /j.amjmed Copyright © 2016 Elsevier Inc. Terms and Conditions
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Figure 1 Physical feature of patient's ascites. Milky-colored ascitic fluid drained from the patient's abdomen. The American Journal of Medicine , e227-e231DOI: ( /j.amjmed ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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Figure 2 Renal biopsy. (A) Fibrin thrombi in a glomerulus (hematoxylin & eosin, 400×). (B) Glomerulus shows variable ischemic changes with wrinkled capillary walls, periglomerular fibrosis (PAS-MS, 600×). (C) Electron microscopy, shows diffuse ischemic wrinkling of the glomerular basement membrane cytoplasmic interposition, diffuse effacement of the podocyte foot processes, no deposits. MS = methenamine silver; PAS = periodic acid–Schiff. The American Journal of Medicine , e227-e231DOI: ( /j.amjmed ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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Figure 3 (A) Lymphoscintigraphy: Tc 99m sulfur colloid was injected at 30 minutes and 4 hours. No evidence of lymphatic obstruction or leakage. (B) Positron-emission tomography-computed tomography of the brain: fluorodeoxyglucose (FDG) intense activity fusing to a right nasal cavity mass and retropharyngeal space. There was no FDG activity in the chest, abdominal or peritoneal cavities. The American Journal of Medicine , e227-e231DOI: ( /j.amjmed ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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