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Archive: August 2019

Art of Medicine: Anti-Brush Border Antibody Disease

Article
The above painting shows massive tubular basement membrane (electron dense on EM) deposits along proximal tubules with sparing of the distal tubules.  This is a finding that can be seen by electron microscopy in anti-brush border antibody disease (ABBA).   Tubular basement membrane deposits are also seen in lupus nephritis (all classes), IgG4-associated kidney disease, idiopathic hypocomplementemic interstitial nephritis, polyomavirus nephritis (BK virus or JC virus), or in response to certain medications (eculizumab, NSAIDS, and others).   Interstitial inflammation is not prominent in ABBA disease, as it is with other pathologies with tubular basement membrane deposits (such as IgG4-associated disease, drug reactions,...
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Twitter Poll (August 28, 2019)

Article
ANSWER: A Dr. Albert Hewett Coons was an American physician, pathologist, and immunologist who conceptualized and developed the immunofluorescence technique for labeling antibodies in the early 1940s. Renal pathologists acquired this technique for the assessment of medical kidney biopsies, and since then it has become the gold standard on routine evaluation. References: Coons, AH, et al. The demonstration of pneumococcal antigen in tissues by the use of fluorescent antibody. J Immunol 1942; 45: 159-170. Coons, AH. The beginnings of immunofluorescence. J Immunol 1961; 97: 499-503.        
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The Strength in Unity

Article
Clap your hands if you are ready to visit Georgia! Yesterday Dr. Tsilosani gave a short presentation which included information about her cultural heritage, her home town, and multiple sightseeing locations in Georgia. She also taught us their flag, main goods, and language.  Booking our plane tickets now...     
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Diagnose This (August 26, 2019)

Article
What is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​ ​  ...
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HIVICK

Article
The patient is a 24 year-old African American male who has recently been diagnosed with HIV infection. He has not received HAART therapy and presents to the hospital with 1.2 g/g of proteinuria and a creatinine of 2.9 mg/dL. Figure 1 shows segmental sclerosis. Figure 2 shows tubular atrophy and interstitial inflammation. Figure 3 shows "hole" formation in glomerular basement membranes. Figures 4, 5, and 6 shows IgG, kappa, and lambda, respectively. Figure 7 shows mesangial and capillary wall electron dense deposits. This is a case of HIV immune complex disease of the kidney (HIVICK). HIV immune complex disease of...
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Dr. Amin Goodbye Party

Article
Dr. Amin will soon be leaving our practice returning to the academic world at West Virginia University.  We gathered today to say our goodbyes and eat cupcakes.  His presence will greatly be missed around this place and we wish him well in his new adventure!   
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Art of Medicine: IgA Nephropathy

Article
The above painting shows glomeruli with mesangial hypercellularity, endocapillary hypercellularity, and crescent formation.  These findings can be seen in IgA nephropathy, and other active glomerulonephritides.  These lesions shown in the painting above are represented in the Oxford Classification for IgA nephropathy.  The Oxford classification is a scoring system on kidney biopsies that  includes mesangial hypercellularity (M0 = <50%, M1 = >50%), endocapillary hypercellularity (E0 = none, E1 = present), segmental sclerosis (S0 = absent, S1 = present), tubular atrophy / interstitial fibrosis (T0 = <25%, T1 25-50%, T2 >50%), and crescents (C0 = absent, C1 = up to 25%, C2...
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Methotrexate-Induced Crystal Nephropathy

Article
The patient is a 50-year-old male who presents with a creatinine of 4.2 mg/dL (baseline 1.0 mg/dL). He has been receiving high dose methotrexate for treatment of osteosarcoma. Image 1 shows a normal glomerulus. Image 2 shows moderate interstitial fibrosis. Image 3, 4, and 5 shows polarizable silver-positive crystals within the tubular lumens. This is a case of methotrexate-induced crystal nephropathy. Methotrexate-induced crystal nephropathy is characterized by acute tubular injury with scattered intratubular and interstitial needle-shaped, golden-brown crystals which are frequently arranged in annular structures. The crystals show birefringence under polarized light and are methenamine silver positive.  Methotrexate-induced crystal nephropathy...
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Disease Week: Onco-Nephrology

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Monday Onco-nephrology is a rapidly developing area of nephrology designed to help address and prevent kidney problems and the many complex issues that arise in cancer patients. AKI is a common complication in cancer patients. The highest 1-year risk of AKI was seen in patients with kidney cancer (44%), liver cancer (33%), and multiple myeloma (31.8%) in one large population-based cohort study. Patients with distant metastases were at highest risk. https://www.ncbi.nlm.nih.gov/pubmed/21767759 What is the most common glomerular pathology reported in patients with solid tumors? Minimal change disease Membranoproliferative glomerulonephritis Membranous nephropathy Thrombotic microangiopathy   Answer: Membranous nephropathy.  The incidence of cancer was significantly higher in patients with...
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Posted January 2nd 2020
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