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Art of Medicine: Lupus Nephritis

The above painting shows features of a proliferative glomerulonephritis.  Endocapillary proliferation, crescent formation, and segmental sclerosis is shown.   These findings can be seen in focal or diffuse lupus nephritis, but are not specific, as they can be identified in other proliferative glomerulonephritides, such as IgA nephropathy, infection-associated glomerulonephritis, and others. Immunofluorescence studies can help in distinguishing lupus nephritis from other forms of proliferative glomerulonephritis, as there is typically a "full house" pattern with expression of all 3 immunoglobulin heavy chains (IgA, IgM, IgG), and complement (C3, C1q), as shown below. Classification of lupus nephritis is through the International Society of...

Pi Day 2019

We had our 2nd Annual Pi Day Contest! It's our most delicious competition. Congratulations to this year's winners: Savory - Aaron (bacon, andouille sausage, and gruyere quiche) Sweet - Tie between Angela (key lime pie) and Amber (pumpkin pie)  

Twitter Poll (March 7, 2019)

ANSWER: True The presence of multiple exostoses due to mutation of the EXT1 gene has been described in a family. There are few isolated reports of extrarenal involvement in patients with type III collagen glomerulopathy, suggesting that the renal lesion may be part of systemic disease in some patients.  References: Cohen AH. Collagen Type III Glomerulopathies. Adv Chronic Kidney Dis. 2012;19(2):101-6. Roberts IS, Gleadle JM. Familial nephropathy and multiple exostoses with exostosin-1 (EXT1) gene mutation. J Am Soc Nephrol. 2008;19:450-453    

Art of Medicine: ANCA-Associated Glomerulonephritis

The painting above shows a crescentic glomerulonephritis and necrotizing arteritis.  A mixed interstitial inflammatory infiltrate is shown in the top left corner, and tubules are dilated with a few red blood cell casts.  This cluster of findings can occur in ANCA-associated disease.  Renal biopsy images representing manifestations of ANCA-associated glomerulonephritis are shown below.  The main differential diagnosis for crescents within glomeruli includes immune complex glomerulonephritides, anti-GBM nephritis, and ANCA-associated glomerulonephritis (pauci-immune), although nearly any glomerulonephritis with mesangial and/or endocapillary proliferation can produce crescents (examples – infection-associated glomerulonephritis, fibrillary glomerulonephritis, and others).  Correlation with ANCA serologies is recommended in any case...

Ehop Visit

This week two of our favorite Ehop coaches were in town for a quick visit.  It's always a treat to spend time for them and be encouraged on our wellness journeys!    

Arkana Physician Spotlight: Dr. Messias

Dr. Nidia Messias joined Arkana Labs in 2010. Previously, Dr. Messias was Assistant Professor in Surgical and Renal Pathology at the Medical College of Georgia in Augusta, GA where she also served as medical director of the electron microscopy laboratory. Dr. Messias completed her residency in Anatomic and Clinical Pathology at the University of Maryland Medical Center and was chief resident during her tenure. She received fellowship training in renal pathology at Johns Hopkins University. At Arkana, Dr. Messias oversees the fellowship program in renal pathology, directs the visiting scholars program, is on the Consensus in Diagnostics Committee, and authors...

Disease Week: Membranous Glomerulopathy

Membranous glomerulopathy: Looking forward Many excellent reviews are available that detail the current state of knowledge in membranous glomerulopathy so I will not attempt to round out this #DiseaseWeek by writing another. Instead, I would like to paint, with broad brush strokes, what I believe to be the near future of diagnostics in membranous glomerulopathy and discuss the techniques of discovery being applied today that are likely to similarly impact other types of immune complex-mediated glomerulonephritis. We live in exciting times for discovery in medicine as the tools available today are so powerful that the molecular pathogenic mechanisms of disease...

Arkana Employee Spotlight: Christa

One of the voices you hear when you call our office belongs to Christa Heller. She joined Arkana in 2014 and has become an integral part of our client service efforts. A core principle here at Arkana is that every call that comes in during business hours should be answered by an actual person. The job of answering the phones here is far from your typical receptionist position. These team members learn the ins and outs of every step required to turn slides into the report that gets delivered to each party involved in the patient’s case.  They are air...