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Archive: March 2019

Art of Medicine: Borderline Changes for TCMR Painting

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

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

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 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)

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

VEGF Inhibitor

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

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 nephritis 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...

Pi Day 2019

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 is an ultra-rare kidney disease of unknown etiology and pathogenesis with only rare cases reported in the literature, the vast majority being case reports. A few non-controlled, small case series exist that shed light on differences in pediatric and adult presentations and specific geographic patient populations. Type III collagen is typically absent in normal glomeruli, although small amounts have been reported in some advanced glomerular diseases. In patients with collagen type III glomerulopathy, abundant type III collagen is seen within the mesangium and lamina rara interna of the capillary loops and typically occurs in a flocculent...