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Archive: June 2019

Twitter Poll (June 26, 2019)

ANSWER: C Severe intimal arteritis (v2), with or without interstitial inflammation and/or tubulitis is considered acute TCMR Grade IIB based on the Banff 2017 classification. However, we now know that arterial lesions (v>0) may be indicative of ABMR, TCMR or mixed ABMR/TCMR and are not restricted to TCMR. Reference: Haas M, et al. The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T-cell mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials. Am J Transplant. 2018; 1-15.    

Arkana Physician Spotlight: Dr. Walker

Patrick D. Walker is the founder of Arkana Laboratories and has more than 40 years of experience in the interpretation of native kidney and renal allograft biopsies. Before founding Arkana Laboratories, Dr. Walker was Chief of the Department of Pathology and Laboratory Medicine at the John L. McClellan Veterans Administration Hospital, Vice-Chairman of the Department of Pathology and Laboratory Medicine at the University of Arkansas for Medical Sciences (1991-2002), and on faculty in the Department of Pathology at Tulane University (1978-1991).   Dr. Walker has a passion for advancing the understanding of disease and has authored more than 100 peer-reviewed...

Diagnose This (June 24, 2019)

Immunofluorescence shows C3 (2-3+), IgM (1+), kappa (trace) and lambda (trace). What is your diagnosis?       ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​...

Art of Medicine: Diabetic Nephropathy

The above painting shows glomeruli with nodular mesangial expansion and arterial hyalinosis, changes frequently seen in diabetic nephropathy. Diabetic nephropathy is graded by the classification system established by the Renal Pathology Society to separate lesions into varying degrees of severity. In class I diabetic glomerulopathy, there are no changes identified by light microscopy, but thickening of the glomerular basement membranes are seen on electron microscopy (see photomicrograph below). Thickened glomerular basement membranes are greater than 471 nm in women or 520 nm in men (in our lab), which represents greater than 2 standard deviations above the normal population. Glomerular basement...

Fellow Graduation

We are experiencing power outages due to storms last night, but that didn’t stop us this morning from celebrating the graduation of our two fellows, Dr. Dvanajscak and Dr. Caza! We're so excited to have these two join our team permanently.     

Twitter Poll (June 13, 2019)

ANSWER: D The use of anticoagulant therapy (warfarin, dabigatran, rivaroxaban, among others) can result in AKI by causing glomerular hemorrhage and renal tubular obstruction by RBC casts. This may be a serious potential complication especially in older patients with underlying chronic kidney injury. References: Glassock RJ. Anticoagulant-Related Nephropathy It's the Real McCoy. CJASN 14:935-937, 2019. Brodsky S, Eikelboom J, Hebert LA. Anticouagulant-Related Nephropathy. J Am Soc Nephrol 29:2787-2793, 2018. Brodsky S, Satoskar A, et al. Acute Kidney Injury During Warfarin Therapy Associated with Obstructive Tubular Red blood Cell Casts: A Report of Nine Cases.  Am J Kidney Dis 54(6):1121-6, 2009....

Diagnose This (June 17, 2019)

The image shown comes from a kidney transplant patient with a rise in serum creatinine. What is the most likely diagnosis and what immunohistochemical stain would you want to rule out a less common disease sometimes seen in kidney transplants?       ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​...

Arkana Employee Spotlight: Drea

Meet Arkana's very own superwoman, Andrea Westra. Drea works on our billing team where her primary job is to handle BCBS and Medicare claims. She keeps track of all payments and appeals and is the go-to person for any billing questions in that area. In addition, she runs the monthly meeting with our billing department, keeping track of the numbers of claims and appeals for each of the different insurance teams. She also works with fee schedules for all of the insurance companies we work with and makes sure payments are consistent with contracted rates. A whiz at detail and...

The Time is Now: Call to Action in Kidney Clinical Trials

Clinical trials investigating novel, targeted agents in kidney disease have been uncommon in the past as endpoints in this field required long studies and large costs. Recently, new surrogate markers have been developed that have allowed many pharma and biotech companies to move into the field of kidney disease. Currently, there are more than 20 clinical trials open to patient enrollment but there is concern about whether they can be filled. If we want better, more targeted drugs for our patients, we must work to fill these trials. Arkana has partnered with NephCure in an effort to get the word...