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Archive: February 2018

Alport IF

In patients suspected of having Alport syndrome, immunofluorescence staining can be used to detect abnormal expression of various alpha chains of type IV collagen. This biopsy from a young girl with hematuria shows discontinuous staining along Bowman's capsule and along the glomerular capillary loops for the alpha 5 chain of type IV collagen (green). In a female patient, this mosaic pattern of decreased or absent staining is suspicious for heterozygous X-linked Alport syndrome. Intact staining of the alpha 2 chains (red) serves as a positive internal control for tissue integrity.

Acute Pyelonephritis in Transplants

Acute pyelonephritis in the transplant setting (allograft pyelonephritis) is a known cause of allograft dysfunction and a complication that occurs in approximately 10-16% of transplanted patients. Given the overlap of clinical findings between acute pyelonephritis and rejection, acute pyelonephritis is seen more often in biopsies performed on allografts than on native kidneys. This 32 year old patient presented with increased creatinine (2.6 mg/dl) 2 years after receiving a deceased donor kidney transplant. As shown in Fig 1 and 2, the biopsy shows severe neutrophilic inflammation associated with remarkable rimming of the tubules, neutrophilic tubulitis and neutrophilic casts. These features are...

Diagnose This! (February 12, 2018)

What is your diagnosis? (Congo red is negative as is routine immunofluorescence)     ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​...

Arkanines: Blaze

Meet Blaze! He is a 4-year-old Pharaoh Hound. Blaze is silly, tends to be a bit mischievous, but is also very affectionate. He has a 3lb Yorkie sister with whom he is very gentle. Blaze belongs to Dr. Cossey.

Granulomatous Interstitial Nephritis Differential

This biopsy is from a 25-year-old African American female with renal failure. The photomicrographs here show renal involvement by non-caseating granulomas eliciting the diagnosis of granulomatous interstitial nephritis. The patient was found to be hypercalcemic and to have hilar lymphadenopathy and reticulonodular infiltrates on chest x-ray and was diagnosed with sarcoidosis. A case series examining 46 cases of granulomatous interstitial nephritis (GIN) by Bijol et al (ref below) found the most common etiology (45%) of this pattern to be a drug-induced reaction. This was followed by sarcoidosis (29% of GIN), other (including infection) at 16% and there were 10% of...

Papillary Necrosis

This kidney biopsy is from an elderly adult patient with acute renal failure and a history of non-steroidal anti-inflammatory medication (NSAID) use. The dominant finding is papillary necrosis, which has two broad etiologies: medullary ischemia and nephrotoxic agents. Medullary ischemia may occur in patients with diabetes, sickle cell anemia, severe arteriolosclerosis, and volume depletion. Nephrotoxic agents associated with papillary necrosis include NSAIDs and phenacetin. It is not possible to know the extent of involvement based solely on core biopsies. The presence of anuria in such a clinical setting would suggest the possibility of diffuse, bilateral disease.

Arkana Physician Spotlight: Dr. Wilson

Dr. Jon Wilson, Arkana Laboratories Physician, neuropathology, molecular pathology
Dr. Jon Wilson joined Arkana Laboratories in 2013 following several years of work in academic centers. He completed a fellowship in molecular pathology at the University of Minnesota in Minneapolis, MI, as well as a fellowship in neuropathology at Stanford University in Palo Alto, CA. Additionally, Dr. Wilson is board certified in both neuropathology and molecular pathology. His knowledge and direction have been instrumental in the development of our muscle and nerve pathology program, as well as our molecular diagnostics laboratory, where he helps create new molecular diagnostic assays utilizing next-generation sequencing. Our lab has also been aided in maintaining...

Diagnose This! (February 5, 2018)

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