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Twitter Poll (April 28, 2021)

Linear GBM Poll
  Answer: Linear GBM   Anti-GBM disease is classically characterized by bright linear staining with IgG by immunofluorescence. By light microscopy, anti-GBM disease typically demonstrates a diffuse necrotizing, crescentic glomerulonephritis. Occasionally, multinucleated giant cells may be seen within the glomerular crescents as well as periglomerular areas. The pathophysiology of the disease is most often due to an autoantibody to the noncollagenous 1 (NC1) domain of the alpha 3 chain of collagen IV, however occasionally antibodies to the NC1 domain of the alpha 5 chain may also be present. Of note, a major prognostic factor at the time of biopsy is...

Diagnose This (April 19, 2021)

AA Amyloid Diagnosis in Renal Biopsy
What is your diagnosis in a 35 y/o male with paraplegia and chronic osteomyelitis who presents with nephrotic syndrome? Bonus: What subtype would you suspect based on the clinical history?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​  ...

Twitter Poll (April 14, 2021)

sickle cell nephropathy, Crescents
Answer: Crescents   Sickle cell disease is an autosomal recessive disorder classically seen in African-Americans which is caused by a single nucleotide change on chromosome 11p15.5 resulting in an amino acid change from glutamic acid to valine. In the kidney, the disease manifests as sickle cell nephropathy. Histologic features seen in this disease include focal segmental glomerulosclerosis, glomerular enlargement, double contour formation, and hemosiderin deposition within tubular epithelial cells to name a few. Crescent formation is not typically seen in sickle cell nephropathy and if seen would be worrisome for a concomitant process (i.e. ANCA-associated glomerulonephritis).      

Twitter Poll (April 1, 2021)

Granulomatous TIN, twitter poll, arkana laboratories
Answer: Granulomatous TIN   The classic finding for renal sarcoidosis is that of a non-necrotizing granulomatous tubulointerstitial nephritis (Granulomatous TIN). However, on biopsy this finding is non-specific and thus the differential diagnosis would also include drug/hypersensitivity reaction, infections (i.e. mycobacterial, fungal), and autoimmune disease. Sarcoidosis is considered a diagnosis of exclusion and thus clinical correlation is required.      

Diagnose This (March 29, 2021)

Light Chain Deposition Disease
What would be your leading diagnosis given the glomerular changes in a patient with an abnormal SPEP? (Hint: Congo red and DNAJB9 stains are negative, powdery deposits by EM)     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​...

Twitter Poll (March 17, 2021)

Minimal Change Disease, arkana laboratories, kidney pathology, renal pathology
Answer: Minimal Change Medullary angiitis is characterized by interstitial hemorrhage within the medulla combined with neutrophilic inflammation with associated karyorrhexis. This finding has been associated with all of the above diagnoses except for minimal change disease. Most often, it has been seen in association with systemic ANCA-associated vasculitis. For more information please see the following reference: References Hendricks AR, et al.  Renal medullary angiitis: A case series from a single institution. Hum Pathol.  2013 Apr;44(4):521-5.      

Diagnose This (March 15, 2021)

What is your diagnosis in a patient (non-smoker) with worsening proteinuria and a negative immunofluorescence panel?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​...

Twitter Poll (March 3, 2021)

Tubulitis, twitter poll, Dr. Joel Murphy, arkana laboratories
Answer: Tubulitis All of the provided answers are used to diagnose antibody mediated rejection, except for tubulitis. Tubulitis is needed for diagnosis of T-cell mediated rejection. For more information on the Banff classification system, see the reference below. References Loupy A, Haas M, Roufosse C, et al. The Banff 2019 Kidney Meeting Report (I): Updates on and clarification of criteria for T cell– and antibody-mediated rejection. Am J Transplant. 2020; 00: 1–14.      

Diagnose This (February 22, 2021)

amyloidosis, Amyloid Spicules on Jones Silver Stain, amyloid spicules with eyelashes, renal pathology
What is your leading diagnosis when seeing this finding along the glomerular capillary loops?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​...

Twitter Poll (February 3, 2021)

SAP, Serum amyloid protein P, twitter poll, renal pathology, arkana laboratories
Answer: C) SAP Serum amyloid protein P (SAP) has been found to be a highly sensitive and specific marker for the diagnosis of Membranous-Like Glomerulopathy with Masked IgG Kappa Deposits. Of note, while these cases show light chain restriction by immunofluorescence, most patients do not have evidence of an underlying paraprotein. For further information about this interesting entity, please see the following references. References Larsen CP, Sharma SG, Caza TN, et al. Serum amyloid P deposition is a sensitive and specific feature of membranous-like glomerulopathy with masked IgG kappa deposits. Kidney Int 2020 Mar;97(3): 602-608. Larsen CP, et al. Membranous-like...