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Pushing Glass (May 2, 2017)

A 45 year-old African American man presented with pneumonia, colitis and acute kidney injury (serum creatinine- 6 mg/dL). What is the most likely diagnosis? A. Infection associated glomerulonephritis B. Ischemic glomerulopathy due to sepsis C. HIV-associated nephropathy D. Focal and segmental glomerulosclerosis E. Acute pyelonephritis Answer: C HIV-associated nephropathy (HIVAN) is a characteristic renal disease developing in the setting of HIV infection. It is manifested clinically by nephrotic-range proteinuria (full nephrotic syndrome is uncommon), acute renal failure and microscopic hematuria and morphologically by collapsing glomerulopathy. Some APOL1 polymorphisms, which are more prevalent in African American, predispose to HIVAN.  HIV-associated immune...

Pushing Glass (April 18, 2017)

A 45 year-old man received renal transplantation for HCV-associated end stage renal disease. He is currently treated with Sofobuvir, Tacrolimus and ACEI. He developed renal function impairment (Serum Cr increased to 2.3 mg/dL) with mild proteinuria. Based on the renal biopsy images, which is the most likely diagnosis? A. Severe acute tubular injury due to Sofobuvir B. Calcineurin inhibitor toxicity C. Polyomavirus nephropathy D. Tubular injury secondary to cryoglobulinemia E. Diabetic nephropathy     The answer is B. The light microscopic examination demonstrates isometric vacuolization of tubular epithelial cells, severe hyaline arteriolopathy and a striped pattern of fibrosis. These features...