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Archive: September 2019

Fellowing Joel: Episode 3

Article
Fellowing Joel, Arkana Laboratories, Renal Pathology, fellowship program
[video width="1920" height="1080" mp4="https://www.arkanalabs.com/wp-content/uploads/Fellowing-Joel_Episode-3.mp4"][/video] It's Friday, and we caught up with Dr. Murphy to see what he has been learning all week! The kidney art on the screen as illustrated by the talented Dr. Stephen Bonsib.    
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Twitter Poll (September 26, 2019)

Article
ANSWER: C APOL1-risk alleles have been reported only on African-derived chromosomes, including individuals from West Africa and recently admixed individuals from the United States or the Caribbean. Approximately 13% of the US African American population carries the APOL1 high-risk genotype. Recent data suggest that this risk is strongly associated with two common variants (G1 and G2) in the last exon of APOL1 that confer resistance to Trypanosoma brucei infections. The highest G1 and G2 allelic frequencies were described in Western, sub-Saharan Africa, with frequencies >40% for G1 in Ghana and Nigeria, and 24% for G2 in Nigeria. REFERENCES: Parsa A, Kao WHL, Xie D,...
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Art of Medicine: Monoclonal Gammopathies of Renal Significance

Article
The above painting is of a bone marrow biopsy showing replacement of the hematopoietic elements with plasma cells, including atypical plasma cells (Mott cells and plasma cells with Dutcher bodies shown).  This can be seen in plasma cell myeloma.   Multiple myeloma can be diagnosed with the presence of a plasma cell myeloma (>10% clonal bone marrow plasma cells), and one or more myeloma-defining events.  These include hypercalcemia, renal insufficiency, anemia, or lytic lesions within bones.   On a kidney biopsy, light chain cast nephropathy is a myeloma defining event and is a paraprotein-associated renal disease.  Other renal manifestations that can occur...
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ALECT2 Amyloidosis

Article
The patient is a 75-year-old Hispanic male who presents with progressively worsening kidney function and a creatinine of 1.6 mg/dl (baseline 1.0 mg/dl). His physician called for a biopsy due to a slowly "creeping" creatinine over the last 8 months. Images 1 & 2 show "apple-green birefringence" on a Congo red stain under polarized light within the interstitium. Image 3 shows mild interstitial fibrosis. Image 4 shows a normal glomerulus on PAS stain and Image 5 shows positive immunohistochemical staining with Lect2. Leukocyte cell-derived chemotaxin 2 (ALECT2) amyloidosis preferentially affects Hispanics (particularly Mexicans) as well as Punjabis, First Nations people...
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Fellowing Joel: Episode 2

Article
Fellowing Joel, Arkana Laboratories, Renal Pathology, fellowship program
Today is Friday! That means it's time to see what our renal fellow, Dr. Murphy, has been learning. [video width="1920" height="1080" mp4="https://www.arkanalabs.com/wp-content/uploads/Fellowing_Joel_Ep_2.mp4"][/video]    
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Clinical Trials: Why Are They Important?

Article
Dr. Abner, Clinical Trials, Arkana Laboratories
At Arkana Laboratories we are actively engaged in a variety of research areas, including clinical trials in which we currently assist in a variety of on-going trials from numerous pharmaceutical companies.  My name is Clint Abner, and I manage clinical trials and contract research here at Arkana. Medical trials are essential to disease research for finding new medications, treatments, and even cures for disease.  They are designed to answer questions that lead to improved health and quality of life for patients.  They can show researchers what does and does not work in humans, and often generate data that cannot be...
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Resolving Membranous Nephropathy

Article
A 40-year-old white male presents with 3 grams/24 hr of proteinuria and swelling around his ankles. He reports that he has had foamy urine over the last 4 months, but was unable to go to a doctor till now because of lack of insurance. Image 1 and image 2 shows irregularly thickened glomerular basement membranes with lamellation. Image 3 shows numerous "holes" on silver stain. Images 4, 5, and 6 show weak staining for IgG, kappa, and lambda, respectively. Membranous nephropathy in a resolving phase can be a tricky diagnosis since the immunofluorescence staining may be extremely weak or negative....
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Twitter Poll (September 12, 2019)

Article
ANSWER: B In a case series by Boils et al. which included 49 patients with GN due to IE, the most common biopsy finding was necrotizing and crescentic GN which was found in 53% of the cases. This was followed by endocapillary proliferative GN in 37% of the biopsies. Reference: Boils CL, et al. Update on endocarditis-associated glomerulonephritis. Kidney Int. 2015; 87(6):1241-1249.  
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Art of Medicine: Plasma Cell Rich Interstitial Nephritis

Article
The above painting shows plasma cell rich interstitial inflammation with lymphocytic and plasma cell tubulitis, findings that can be seen in plasma cell rich interstitial nephritis.  Acute interstitial nephritis can have an inflammatory infiltrate with lymphocytes, plasma cells, eosinophils, neutrophils, and/or histiocytes.  Greater than 10 percent plasma cells would be considered “plasma cell rich”.  An H & E stained section of a plasma cell rich infiltrate is shown below. The differential diagnosis for a plasma cell rich interstitial nephritis in native kidney biopsies includes drug reactions, Sjögren's syndrome, chronic pyelonephritis, and IgG4-related kidney disease.  IgG4-related kidney disease is characterized by...
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