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Archive: August 2019

Art of Medicine: Anti-Brush Border Antibody Disease

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,...

Twitter Poll (August 28, 2019)

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.        

The Strength in Unity

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...     

Diagnose This (August 26, 2019)

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

HIVICK

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...

Dr. Amin Goodbye Party

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!   

Art of Medicine: IgA Nephropathy

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...

Methotrexate-Induced Crystal Nephropathy

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...

Disease Week: Onco-Nephrology

The rapidly evolving field of oncology and cancer management creates unique opportunities as well as challenges for the nephrology community.  As such, it is important for nephrologists and nephropathologists to be informed and involved in its many aspects in order to better care for patients and be valuable members of a multidisciplinary cancer care team.  The renal manifestations and complications of cancer are myriad and include acute as well as chronic kidney injury, electrolyte/acid–base disturbances, direct injury of the kidney through tumor infiltration and/or paraneoplastic substances, pharmacokinetics of chemotherapeutic agents, and hematopoietic cell transplantation-related kidney injury.  Kidney transplant patients also...