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Archive: February 2020

Art of Medicine: Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits

Article
Small destructive B cell or plasma cell clones may be responsible for disease development. The above painting shows normal bone marrow, containing erythroid and myeloid precursors at various stages of maturation and normal trabeculae.   Bone marrow biopsies may be performed to evaluate for a lymphoid or plasma cell clone in patients with monoclonal gammopathies of undetermined significance (MGUS) and in work-up of patients found to have a monoclonal gammopathy of renal significance (MRGS).  Monoclonal gammopathies of renal significance occur when light chain restriction within a kidney biopsy is thought to be responsible for the patient's renal dysfunction, which is usually...
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Common Misconceptions in Renal Pathology

Article
Misconception #1: Renal Pathology is Too Hard The truth is that renal pathology can be more complicated than other areas of pathology because it is a clinicopathologic field and to practice it well you need to have a good grasp of certain clinical topics in nephrology. Of course, in pathology residency, you don't get any exposure to nephrology so every pathologist that tries to learn renal pathology is handicapped until they gain sufficient clinical knowledge to utilize in interpreting the patterns they see on biopsy. For our fellows, this process usually takes a few months before they gain confidence. Renal...
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Diagnose This (February 24, 2020)

Article
Purple microscopic image demonstrating multiple large, polarizable intratubular crystals characteristic of calcium oxalate.
The light microscopic image demonstrates multiple large, polarizable intratubular crystals characteristic of calcium oxalate. While an occasional calcium oxalate crystal is not uncommon to see in renal biopsies, especially in patients with chronic kidney disease, this case demonstrated numerous crystals throughout the sample consistent with a diagnosis of renal oxalosis. Renal oxalosis is typically a progressive tubulointerstitial disease (although can occur acutely) with many causes which can be classified as secondary to increased ingestion, increased absorption, decreased excretion, or vitamin deficiency. Increased enteric absorption of oxalate occurs secondary to malabsorptive states such as gastric/intestinal bypass surgery (as seen in this...
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Fellowing Joel- Episode 16

Article
Fellowing Joel, Joel Murphy, Renal Pathology
This week we caught up with Dr. Murphy as he put the finishing touches on his ABBA presentation for USCAP 2020! [video width="1920" height="1080" mp4="https://www.arkanalabs.com/wp-content/uploads/02/26/Episode-18-Final.mp4"][/video]
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Twitter Poll (February 19, 2020)

Article
screenshot of twitter poll
ANSWER: C The Oxford IgAN Classification takes in consideration the percentage of interstitial fibrosis and tubular atrophy (T) as one of the histologic findings to predict outcome, irrespective of treatment. T0 represents <25%, T1 26-50% and T2 >50% cortical involvement. REFERENCES: 1. Trimarchi et al. Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int 2017; 91(5):1014-1021. 2. Haas et al. A multicenter study of the predictive value of crescents in IgA nephropathy. J Am Soc Nephrol 2017; 28:691-701.
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A Day in the Life of a Renal Pathologist

Article
8:30-10:00am: I get to work and have some coffee. For most physicians, this time of day is devoted to research, reading & writing, teaching conferences or even dropping the kids off at school. As the Physician Chief at Arkana, my mornings are usually filled with meetings. My meetings typically are with members of the physician team who have areas of responsibility they oversee or with the content team where we create all the content you see on Arkana’s Twitter/Facebook and Blog. One day a week I try to devote this time to my research projects.  10:00-11:00am: I attend our daily case conference...
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Diagnose This (February 17, 2020)

Article
Question: What is the Diagnosis?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​     ​   ​ ​   ​   ​ ​   ​   ​  ...
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Twitter Poll (February 12th)

Article
Answer: C Transplant glomerulopathy (TG) is characterized by duplication of glomerular basement membrane (GBM) and is graded based on the percentage of glomerular capillary loops with GBM duplication or double contours in the most affected non-sclerotic glomerulus by LM. TG often indicates the presence of chronic antibody mediated rejection, for which there will be glomerulitis (B), C4d positivity in PTCs (C), and mesangial matrix increase (A).  These findings are not in isolation from one another, therefore, "all of the above" would also be a correct answer. The Banff Lesion Score cg is based on the presence and extent of GBM double...
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Twitter Poll (February 5, 2020)

Article
ANSWER: D 2,8-dihydroxyadeninuria (DHA) disease is a rare autosomal recessive disorder caused by complete adenine phosphoribosyltransferase (APRT) deficiency and manifests as recurrent nephrolithiasis. 2,8-DHA can lead to irreversible renal failure and frequently recurs in the transplants. For the blog: Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive inherited disorder of purine metabolism. APRT catalyzes the formation of adenosine monophosphate from adenine. In the absence of APRT activity, adenine is catabolized by xanthine oxidase to 2,8-dihydroxyadenine (DHA), which is excreted in the urine. DHA is insoluble in the urine at the physiological range of pH, which may lead to crystalluria....
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Anti-Brush Border Antibody Disease (ABBA)

Article
What is your diagnosis?    ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​ ​   ​...
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Arkana
Announcement

Posted January 2nd 2020
You can now pay your bill online.
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