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Archive: March 2019

Art of Medicine: Borderline Changes for TCMR Painting

Borderline Changes for TCMR
The painting above of a kidney transplant biopsy shows mild interstitial inflammation and tubulitis.   If this field is representative, these changes would be consistent with borderline changes suspicious for T cell-mediated rejection (TCMR).   A diagnosis for borderline changes suspicious for TCMR can be made with mild interstitial inflammation (i1; 10-25% of cortex) with any degree of tubulitis (i1t1 with 0-4 lymphocytes/tubular profile, i1t2 with 4-10 lymphocytes per tubular profile, i1t3 with >10 lymphocytes per tubular profile or tubular basement membrane rupture), by moderate interstitial inflammation (25-50% of cortex) with mild tubulitis (i2t1), or with isolated tubulitis without interstitial...

Cryoglobulinemic Glomerulonephritis

Acute kidney injury, chryoglobulinemia, glomerulonephritis, hyaline thrombi, masked deposits, paraffin immunofluorescence, Cryoglobulinemic Glomerulonephritis
The patient is a 60-year-old male who presents with proteinuria, hematuria, and a creatinine of 2.8 mg/dL. He was in his normal state of health until 2 weeks ago when he noticed he was having trouble putting on his shoes. Serologies show low complements and an albumin of 2.3 g/dL. Serologies for ANA, c-ANCA, p-ANCA, hepatitis B, and hepatitis C are negative. No monoclonal spike is found on serum electrophoresis. Figure 1 shows accentuation of lobulation with both mesangial and endocapillary hypercellularity. This is a membranoproliferative pattern. Figure 2 shows a small, hyaline thrombus. Figure 3 shows moderate interstitial fibrosis....

Dr. Lorraine Racusen Visit

Dr. Lorraine Racusen, Arkana Laboratories, Arkana Visualized
We were lucky to get to spend time with Dr. Lorraine Racusen this morning at Arkana. We may have even brought a few extra kidney transplant cases to conference to capitalize on learning from such a distinguished kidney transplant expert!    

Arkana Physician Spotlight: Dr. Bell

Dr. Bell, Arkana Laboratories physician
Dr. Bell graduated in 1981 from the University of Nebraska with a BS in Life Sciences (with Highest Distinction), and in 1985 from the University of Iowa Carver College of Medicine. She completed a pathology residency at the University of Arkansas for Medical Sciences and was chief resident during her tenure. After residency, Dr. Bell joined UAMS as an Assistant Professor in anatomic and clinical pathology and later had appointments at Baptist Medical Center in Little Rock as well as Arkansas Children’s Hospital before coming to Arkana (then Nephropath) in 2004. Dr. Bell was the first renal pathologist fellow to...

Diagnose This (March 25, 2019)

Nephrotic Syndrome, Arkana Laboratories, renal pathology, kidney injury
What is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​ ​  ...

VEGF Inhibitor

VEGF, VEGF inhibitor, arkana laboratories, renal pathology
The patient is a 70-year-old white female who presents with 4 gm/24 hr proteinuria and a creatinine of 1.2 mg/dl. She has colon cancer with metastases to the liver, treated with chemotherapy and Avastin. The patient has recently had anemia, thrombocytopenia, ascites, and a urinary tract infection treated with nitrofurantoin. Her blood pressure has been under good control at 120/80. Figure 1 shows acellular closure of the capillary lumens and a "cotton-candy" appearance of the mesangium. Figures 2 and 3 shows capillary microaneurysms and segmental capillary hyalinosis. Figure 3 additionally shows double contours. Figure 4 shows moderate interstitial fibrosis. Figure...

Art of Medicine: Lupus Nephritis

lupus nephritis, art of medicine
The above painting shows features of a proliferative glomerulonephritis.  Endocapillary proliferation, crescent formation, and segmental sclerosis is shown.   These findings can be seen in focal or diffuse lupus nephritis, but are not specific, as they can be identified in other proliferative glomerulonephritides, such as IgA nephropathy, infection-associated glomerulonephritis, and others. Immunofluorescence studies can help in distinguishing lupus from other forms of proliferative glomerulonephritis, as there is typically a "full house" pattern with expression of all 3 immunoglobulin heavy chains (IgA, IgM, IgG), and complement (C3, C1q), as shown below. Classification of lupus nephritis is through the International Society of Nephrology...

Pi Day 2019

Pi Day Contest, Arkana Laboratories, Arkana Visualized,
We had our 2nd Annual Pi Day Contest! It's our most delicious competition. Congratulations to this year's winners: Savory - Aaron (bacon, andouille sausage, and gruyere quiche) Sweet - Tie between Angela (key lime pie) and Amber (pumpkin pie)  

Disase Week: Collagen Type III Glomerulopathy

Collagen Type III Glomerulopathy, disease week, arkana laboratories, renal pathology, nephropathology
Monday Type III collagen glomerulopathy was first described by Arakawa in 1979 in Japan. In this first report it was dubbed 'Idiopathic mesangio-degenerative glomerulopathy.' Arakawa M. Idiopathic mesangio-degenerative glomerulopathy. Jpn J Nephrol1979; 21: 914–915   Collagen type III glomerulopathy is an ultra-rare kidney disease with approximately 40 cases reported in the literature. Reports from Japan are most common but reports are widespread. https://www.ncbi.nlm.nih.gov/pubmed/26622504 Collagen type III glomerulopathy is caused by the abnormal accumulation of type III collagen within the glomerular mesangium and capillary walls. https://www.ncbi.nlm.nih.gov/pubmed/28532638 Collagen type III glomerulopathy is also sometimes called collagenofibrotic glomerulopathy, especially in the past. However, in recent times,...