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Archive: March 2018

Spiritual Wellness

Spiritual Wellness is a personal matter involving values and beliefs that provide a purpose in our lives. The path to spiritual wellness may involve meditation, prayer, affirmations, or specific spiritual practices that support your connection to a higher power or belief system. Yoga and meditation can also help you develop spiritual wellness. Having compassion, the capacity for love and forgiveness, altruism, joy, and fulfillment help you enjoy your spiritual health. Your religious faith, values, beliefs, principles, and morals define your spirituality. Source: https://wellness.ucr.edu/spiritual_wellness.html 

Membranous-Like Glomerulopathy with Masked IgG-Kappa Deposits

Immunoglobulin deposits identified on renal biopsy samples by paraffin immunofluorescence that show negative staining by routine immunofluorescence on frozen tissue have become known as “masked” deposits. Membranous-like glomerulopathy with masked IgG kappa (κ) deposits is a recently recognized pattern of immune complex deposition characterized by masked deposits that show IgG κ restriction and are subepithelial and mesangial by electron microscopy. The subepithelial deposits can be appreciated (arrow) in the Jones methenamine silver stain shown here. The patients are most commonly young females <40 years of age with positive autoimmune serologic study results such as ANA, although a few carry a diagnosis...

Chronic Active T Cell-Mediated Rejection

Chronic active T cell-mediated rejection (TCMR) was included in the 2017 Banff classification system for the evaluation of kidney allografts (see reference).  This diagnosis recognizes the usually deleterious effects of interstitial inflammation on graft survival, even within areas of interstitial fibrosis and tubular atrophy (IFTA).  The biopsy shows severe chronic inflammation (Fig. 1) in the setting of moderate to severe IFTA (Fig. 2), as well as foci of severe tubulitis in non-atrophic tubules (Fig. 3).  Haas M, Loupy A, et al.  Am J Transplant. 2018 Feb;18(2):293-307. PubMed PMID: 29243394

Resolving Membranous Glomerulopathy

A renal biopsy was performed on this 55-year-old female with a history of biopsy-proven membranous glomerulopathy status post immunosuppressive therapy, with a partial clinical response. The patient is currently being worked up for persistent subnephrotic proteinuria. This representative electron micrograph shows globally thickened capillary loops by a combination of intramembranous electron dense deposits completely surrounded by neomembrane (Ehrenreich and Churg stage III, blue arrow) and intramembranous electron lucent deposits with glomerular basement membrane remodeling (Ehrenreich and Churg stage IV, red arrow). These findings are compatible with a resolving membranous glomerulopathy. In light of these electron microscopy findings, the presence of...

Diagnose This (March 26, 2018)

In the setting of weak C3 (1-2+) only staining by routine immunofluorescence, what is your diagnosis?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​...

Arkanines: Zeus

Meet Zeus! He is a 15-month-old Great Pyrenes. Zeus was originally brought to a goat farm to be a goat protector but only wanted to take naps on the couch. He loves belly rubs, puppuccinos from Starbucks, and going on walks, sometimes by himself because he can open the front door. Zeus belongs to Jill, who works on our transcription team.

Pushing Glass (March 23, 2018)

These images are from the kidney biopsy of a 70-year-old woman with a history of hypertension and valvular heart disease presenting with renal failure and serum creatinine of 4 mg/dl. The findings are suggestive of a mutation in which of the following genes: A. Podocin B. Glucocerebrosidase C. a-galactosidase A D. Nephrin E. Phospholipase C Answer: C The images highlight podocytes loaded with numerous myelinosomes. There are only a few causes that can cause such accumulation, most notably Fabry disease. However, rare secondary causes to be considered include drugs such as chloroquine and chloroquine-like drugs (e.g., Plaquenil), amiodarone, aminoglycoside antibiotics,...

Congo Red Stain Tutorial

Positive Congo red staining in tissue with apple-green birefringence under polarized light is diagnostic of the presence of amyloid fibrils. Image A shows a glomerulus with Congo red positive mesangial staining while image B shows a renal biopsy with diabetic nephropathy that is negative for Congo red. Accurate interpretation of this stain hinges upon proper optimization so that there is elimination of nonspecific background staining.