This presentation will give an overview of the uses of electron microscopy in neuropathology, with a focus on muscle and nerve biopsies.

Background: Sickle Cell Nephropathy (SCN) is a well-recognised complication of sickle cell disease (SCD) which encompasses a spectrum of clinical and histopathological renal manifestations. Diagnosing SCN through renal biopsies can be challenging due to variable and sometimes overlapping pathological changes. In such cases, a holistic approach integrating the clinical history is pivotal to the assessment.
Purpose: This study aims to showcase the histopathological features of SCN at an ultrastructural level through a detailed exploration of electron microscopy (EM) findings in a renal biopsy of a 45-year-old male with known SCD. Information from light microscopy (LM) and direct immunofluorescence (DIF) studies will also be discussed for a comprehensive view.
Methods: An examination of the patient’s clinical history and histopathological findings took place. In addition to the various SCD-related organopathies, the patient was known to have chronic kidney disease and proteinuria. A significant increase in the nephrotic range of proteinuria prompted an elective renal biopsy to investigate possible causes.
Results: Histopathological examination of the glomeruli revealed focal segmental glomerular sclerosis (FSGS), glomerular basement membrane (GBM) thickening and wrinkling, and severe podocyte foot process effacement. Capillaries appeared congested and some contained small aggregates of sickled erythrocytes. Tubular injury and atrophy, interstitial fibrosis, in addition to the deposition of hemosiderin in both tubules and the interstitium was present. No electron dense deposits on EM and no immune reactants on DIF were identified, further affirming the diagnosis of SCN.
Conclusions: The integration of microscopic findings from LM, EM and DIF strongly confirmed the diagnosis of SCN. Notably, the presence of FSGS in this case prompted further considerations, including the possibility of secondary FSGS. This study emphasises the importance for a comprehensive integration of clinical and histopathological findings for accurate diagnosis and highlights the importance of ultrastructural findings for diagnostic purposes and overall understanding of disease.