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Archive: December 2018

Christmas Lunch

Today we all gathered for a delicious Christmas lunch and presented the Walkers with a gift from all of the staff - donations to the charity of their choice. ♥️      

A tale of two cores…

Core “A” and “B” were taken from the same patient during the same biopsy procedure. The red blood cells within the tubules in core “B” represent a biopsy artifact sometimes seen when multiple passes are made during the same biopsy procedure. One confirmatory clue is the presence of red blood cells surrounding the periphery of core “B” – these are not present in core “A” which was likely the first core taken during the biopsy.    

Diagnose This (December 10, 2018)

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

Twitter Poll (December 7, 2018)

ANSWER: D MGRS was introduced to acknowledge a clonal plasma cell or B lymphocyte proliferation causing a renal lesion in the absence of hematologic malignancy or other myeloma-defining events; the renal lesion is a consequence of the MIg, which carries major implications for management and prognosis, including the potential for progressive renal injury and ESRD. MGRS caused by PC is defined as <10% bone marrow plasma cells (BMPCs), <3 g/dl of M protein, and the presence of renal lesions without any other myeloma-defining events (CRAB features; clonal PC ≥60%; serum FLC ratio of ≥100; or >1 focal lesion on magnetic...

Pushing Glass (December 7, 2018)

The patient is a 50-year-old female who presents 2 days after a renal transplant with a delay in graft function and a creatinine of 7. Her end-stage renal disease was due to diabetic glomerulopathy. She was on dialysis for 3 years. She received a kidney from a 22-year-old deceased donor (motorcycle accident). The kidney at time of transplant looked normal grossly and microscopically. What is the most likely cause of the patient’s delay in graft function? A. Acute Cellular Rejection B. Surgical manipulation of a vessel C. Recurrent diabetes D. Donor-derived disease   The correct answer is (B) surgical manipulation...

Angel Tree

'Tis the season of giving! Our very own Christa was kind enough to organize this opportunity for us to be a part of the Salvation Army's Angel Tree program. For more information on this program, or for more ways to give, visit http://salvationarmyaok.org/caac/volunteer/support-the-angel-tree/.     

Where is the normal kidney tissue?

This kidney biopsy shows the histologic features characteristic of malakoplakia, which includes a dense, often obliterative, inflammatory infiltrate rich in histiocytes (Fig. 1 and 2) with numerous small intracytoplasmic concretions known as Michaelis-Gutmann bodies (these are best identified using histochemical staining for calcium as in Fig. 3). Malakoplakia is thought to result from chronic bacterial infection of the urinary tract (the most common causative organism is E. coli). Many cases are associated with the formation of small plaques and/or mass lesions. The bladder is the most common site of involvement, but kidney involvement occurs in about 15% of cases. The...

Twitter Poll (November 30, 2018)

ANSWER: D The cells of Goormaghtigh, AKA extraglomerular mesangial cells, lacis cells or Polkissen cells, are part of the juxtraglomerular apparatus. Ultrastructurally, these cells resemble mesangial cells. The lacis cells function as a physiologic liaison between the macula densa and arteriolar smooth muscle cells and the arteriolar granular myoepithelioid cells. They play an important role in renal autoregulation of blood flow to the kidney and regulation of systemic blood pressure through the renin-angiotensin system. References: Eknoyan G, Rubens R, Lameire R. The juxtaglomerular apparatus of Norbert Goormaghtigh – a critical appraisal. Nephrol Dial Transplant 2009; 24:3876-81. Christensen JA, Bohle A...

Diagnose This (December 3, 2018)

What is your diagnosis? What would you want to confirm your diagnosis?           ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​  ...