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Archive: November 2018

Step By Step

Article
The biopsy is from a 65 year-old female who presented with acute renal failure and elevated creatinine up to 1.9 mg/dl.  She has non-ischemic cardiomyopathy and protein electrophoresis is positive for lambda light chains.  Serologies for ANA and rheumatoid factor are within normal limits.  A biopsy was performed to rule out paraprotein associated disease and there was a specific concern for amyloidosis, due to cardiac changes. The biopsy consisted of a good sample, contained multiple cores of tissue and more than 20 glomeruli.   The glomeruli were very unremarkable by light microscopy – loops were open, with regular contours, and no...
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Arteriole Transition

Article
The image captures the transition of an arteriole as it loses its internal elastic lamina (black arrow).  Note that the smaller arteriole branch, while lacking this elastic layer, still retains smooth muscle cells (red arrow).  The elastic tissue adds structural integrity to arterial and larger arteriolar walls during pulsatile distension from higher intravascular pressure, and the retained muscular layer in small arterioles helps provide an important component of the pre-capillary sphincter mechanism, whereby regulation of blood flow to capillary beds occurs.    
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Diagnose This (November 19, 2018)

Article
What is your diagnosis? What additional stains would you like to confirm your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​...
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Arkana Square Dance

Article
This past weekend we had a square dance!  It was held at a beautiful location called Cold Springs Events, which is a short 20-minute drive outside of the city.  We also enjoyed delicious food from Heritage Catering.   Good food and dancing in a beautiful atmosphere make for a great night. 
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Twitter Poll (November 15, 2018)

Article
ANSWER: A The number of nephrons in the normal kidney is important because they may play a role in the development of hypertension and progression of chronic renal disease. Nephron number is influenced by many factors that affect renal development. References: 1. Luyckx VA, Brenner BM. The clinical importance of nephron mass. J Am Soc Nephrolo 2010;21:898-910. 2. Bertram JF, Douglas-Denton R, et al. Human nephron
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Diagnose This (November 12, 2018)

Article
What is your diagnosis and what do you need to prove it?           ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​  ...
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IgA nephropathy with something extra…

Article
The biopsy is from a 61-year-old man with a history of intermittent microscopic hematuria for many years who presents with recent 18-pound weight loss and nephrotic syndrome.  His creatinine is mildly elevated at 1.3 mg/dL.  He has 12.5 g of proteinuria and his serum albumin is 2.6 mg/dL.  The biopsy shows diffuse mild mesangial matrix expansion with no necrosis or proliferative lesions (Fig. 1).  Immunofluorescence microscopy shows extensive granular mesangial IgA deposits (3+) (Fig. 2), compatible with IgA nephropathy.  Interestingly, the Jones methenamine silver stain also shows argyrophilic spikes involving capillary loops, which are most suggestive of spicular amyloid deposits...
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Diagnose This (November 5, 2018)

Article
What renal state do these glomerular changes represent?    ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​  ...
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Twitter Poll (November 1, 2018)

Article
ANSWER: D Drug-induced AIN may account for 60-70% of AIN cases. Some offending drugs include: antibiotics, proton pump inhibitors, NSAIDs, PD1-inhibitors, anti-convulsants, and diuretics, among others. References: Cortazar FB et al. Clinicopathological features of acute kidney injury associated with immune checkpoint inhibitors. Kidney Int 2016; 90: 638-47 Muriithi AK et al. Clinical characteristics, causes and outcomes of acute interstitial nephritis in the elderly. Kidney Int 2015; 87: 458-464. Muriithi AK et al. Biopsy-proven acute interstitial nephritis. Nat Rev Nephrol 2010; 6(8): 461-70 Praga M et al. Acute interstitial nephritis. Kidney Int 2010; 77(11): 956-61
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Diana Retirement

Article
We said farewell this week as one of our long-time colleagues stepped into retirement bliss.  Here are a few words about Diana from her supervisor, Arkana Financial Manager, Neal Daugherty: On behalf of Arkana, I want to thank Diana for her conscientiousness and her hard-working service toward the company during the last eleven and half years.  Over that time, she has seen the company grow and mature and she responded to every challenge with courage and perseverance.  Personally, I appreciate the guidance she provided over my tenure with her and her graciousness as I learned Arkana.  She is truly a...
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Arkana
Announcement

Posted January 14th 2019
Your patients can now pay their bill online.
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