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Archive: May 2017

Embryonal Hyperplasia of Bowman’s

H&E and PAS-stained sections from the kidney of an 8-year-old male with advanced nephrosclerosis of unknown etiology. An exuberant proliferation of epithelial cells with an embryonal or immature appearance, arranged in a tubular and nodular pattern, is seen surrounding globally sclerotic glomeruli.  This unusual finding termed “embryonal hyperplasia/metaplasia of Bowman’s capsule epithelium” has been described in patients with end-stage renal disease on long-term dialysis. More recently, this finding has also been associated with WT1 mutations in patients with Denys-Drash syndrome and isolated diffuse mesangial sclerosis. The clinical significance of this finding is yet to be determined. References: Hughson MD, McManus...

Diagnose This! (May 8, 2017)

What is your diagnosis?     ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​...

Arkana Physician Spotlight: Dr. Bonsib

Dr. Bonsib, Nephropathologist, Arkana Laboratories Doctors
Dr. Bonsib joined Arkana Laboratories in 2012 following five years as Chair of Pathology at the Louisiana State University Health Sciences Center in Shreveport, LA. He received his BA, MS, and MD from Indiana University. Dr. Bonsib published an incredible renal atlas in 2013 that shows his incredible dissection, photography and renal anatomy/pathology skills (Atlas of Medical Renal Pathology). He is also involved with our Patient Education Committee which helps produce patient resources about kidney disease. In his free time, Dr. Bonsib enjoys raising orchids and bonsai trees and drawing. Dr. Bonsib’s favorite quote is “Good better best, never let...

Oxalate Nephropathy

This biopsy is from a patient with metabolic acidosis, a CPK of 8000 mg/dl a creatinine of 22 mg/dl on admission. The H&E stained section shows birefrigent bluish crystals consistent with calcium oxalate crystals on a background of acute tubular injury. The extensive number of intratubular crystals associated with acute tubular injury support renal oxalosis as the cause of the renal failure. (H&E with polarized light, 200x)

Arkanines: Stella

Arkanines: Stella, Arkana Laboratories
Meet Stella! She's a young pup, but already loves to terrorize her older, yet smaller brother. She belongs to Allison, who is on our neuropathology lab team.

Dr. Hobby Visit

We're so excited to have University of Arkansas for Medical Sciences Nephrology Fellow Dr. Gerren Hobby join us for the next two weeks!

IgA Nephropathy

Figure 1 shows a renal biopsy from a 29-year-old man with no significant past medical history, who was found to have microscopic hematuria and non-nephrotic range proteinuria. The glomeruli show minimal mesangial matrix expansion and segmental hypercellularity. No crescents are identified. The surrounding tubules appear normal. Figure 2 shows dominant IgA mesangial deposits, consistent with IgA nephropathy. Remember that IgA deposits often persist and are seen in repeat biopsies even in patients who receive immunosuppressive therapy. Also, note the recent recommendation to include the presence or absence of crescents in the Oxford classification score (https://www.ncbi.nlm.nih.gov/pubmed/28341274).

Pushing Glass (May 2, 2017)

A 45 year-old African American man presented with pneumonia, colitis and acute kidney injury (serum creatinine- 6 mg/dL). What is the most likely diagnosis? A. Infection associated glomerulonephritis B. Ischemic glomerulopathy due to sepsis C. HIV-associated nephropathy D. Focal and segmental glomerulosclerosis E. Acute pyelonephritis Answer: C HIV-associated nephropathy (HIVAN) is a characteristic renal disease developing in the setting of HIV infection. It is manifested clinically by nephrotic-range proteinuria (full nephrotic syndrome is uncommon), acute renal failure and microscopic hematuria and morphologically by collapsing glomerulopathy. Some APOL1 polymorphisms, which are more prevalent in African American, predispose to HIVAN.  HIV-associated immune...

Postpartum HUS

This 22-year-old Caucasian female presented with acute renal failure and proteinuria five days after delivering her first child. The pregnancy was uneventful. Serum creatinine at presentation was 6.2 mg/dL (baseline of 0.8 mg/dL), hemoglobin 2.5 g/dL, platelets 22,000 and LDH 2300 U/L. The biopsy shows glomeruli with endocapillary fibrin thrombi, associated with segmental mesangiolysis and red blood cell fragmentation.  These findings are diagnostic of a thrombotic microangiopathy (TMA).  Numerous etiologies may lead to a TMA, all of which show morphologic overlap with no morphologic finding specific for a single etiology.  Given the clinical history and the timing of disease presentation...