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Pushing Glass (May 11, 2018)

Lithium-Induced Nephropathy, kidney disease, arkana laboratories, acute renal disease
These images are from the kidney biopsy of a 45-year-old man with a history of hypertension and bipolar disease presenting with renal failure. Serum creatinine is 3 mg/dl. Which of these elements has been associated with some of the findings in this biopsy? A. Potassium B. Lithium      C. Sodium D. Antimony E. Gold Answer: B. Lithium The features seen in this biopsy are suggestive of lithium-induced nephropathy. This develops in patients taking lithium-containing medications for prolonged periods, usually 10-20 years, and can manifest decades after the medication has been stopped. It typically shows a chronic tubulointerstitial nephropathy, usually out of...

Pushing Glass (March 23, 2018)

A-galactosidase A , pushing glass, arkana laboratories, kidney disease
These images are from the kidney biopsy of a 70-year-old woman with a history of hypertension and valvular heart disease presenting with renal failure and serum creatinine of 4 mg/dl. The findings are suggestive of a mutation in which of the following genes: A. Podocin B. Glucocerebrosidase C. a-galactosidase A D. Nephrin E. Phospholipase C Answer: C The images highlight podocytes loaded with numerous myelinosomes. There are only a few causes that can cause such accumulation, most notably Fabry disease. However, rare secondary causes to be considered include drugs such as chloroquine and chloroquine-like drugs (e.g., Plaquenil), amiodarone, aminoglycoside antibiotics,...

Pushing Glass (January 26, 2018)

An otherwise asymptomatic 65-year-old man presents for medical evaluation after 15 years of not seeing a physician. He was noted to have an abnormal D-dimer test and was referred for further evaluation to the emergency department where his serum creatinine was found to be 5 mg/dL. Urinalysis showed 2+ proteinuria and 3+ blood. A renal biopsy was ordered. The images are characteristic findings of which of the following: 1. Amyloidosis 2. Fibrillary Glomerulopathy 3. Monoclonal immunoglobulin deposition disease 4. Dense Deposit Disease 5. Lupus nephritis 6. Anti-brush border antibody disease Choice 3 - Monoclonal immunoglobulin deposition disease (MIDD) is characterized...

Pushing Glass (September 6, 2017)

A 70-year-old man undergoes kidney biopsy because of worsening renal function. His medical history is otherwise significant for hyperlipidemia, type II diabetes mellitus, hypertension, gout, coronary artery disease, s/p CABG 10 years ago and congestive heart failure. Serum creatinine is 6 mg/dl. Serological studies are negative. Urinalysis shows proteinuria of up to 1.5 g/day. What is the most potentially correctable factor contributing to his worsening of renal function? a. Diabetic glomerulosclerosis b. Atheroembolism c. Uric acid nephropathy d. Hypertensive arteriosclerosis e. Interstitial nephritis The answer is B. Atheroembolism.  At low magnification, this biopsy shows features of advanced interstitial fibrosis and...

Pushing Glass (August 8, 2017)

A 69-year-old man with past medical history of hypertension presents with nephrotic syndrome and 7 gm/day proteinuria. Serological studies are negative for hepatitis B and C. The images are characteristic findings of which of the following: 1. Amyloidosis 2. Fibrillary Glomerulopathy 3. Light chain deposition disease 4. Diabetic nephropathy 5. Fibronectin glomerulopathy This is a case represents classic findings of fibrillary glomerulopathy. Fibrillary glomerulopathy has been found to be associated with hepatitis C infection, malignancy, dysproteinemia and autoimmune disease (see References below). The deposits in fibrillary glomerulopathy are weakly PAS-positive, silver negative and Congo red negative. By electron microscopy, there...

Pushing Glass (July 11, 2017)

A 24 day-old phenotypic female baby presents with nephrotic syndrome. Her medical history is significant for severe combined immunodeficiency syndrome (SCIDS) (diagnosed during newborn screen) and congenital nephrotic syndrome. She did not have any dysmorphic features. There is no history of premature delivery or other birth defects. Parents are of Native American ancestry. Investigations show serum albumin of 1.2 g/dL. Urine protein/creatinine ratio is 44. Investigations for TORCH infections are negative. Serological studies including HIV are also negative. The images are characteristic findings of which of the following? 1. Diffuse mesangial sclerosis 2. Denys-Drash Syndrome 3. Minimal change disease 4....

Pushing Glass (June 13, 2017)

A 69-year-old African American woman had a kidney biopsy due to CKD III-IV. Her medical history is significant for morbid obesity, diabetes mellitus (>5 years), hypertension (>5 years), coronary artery disease status post stent, hypothyroidism, gout and chronic kidney disease. Her renal ultrasound shows an unremarkable simple left renal cyst and increased echogenicity in both kidneys. Investigations show serum creatinine which has increased to 4.9 mg/dl. Proteinuria is up to 3.7 gm/day. Serological studies are negative. The images are characteristic findings of which of the following: 1. Sarcoidosis 2. Acute Tubular Injury 3. Uric Acid Nephropathy 4. Interstitial Nephritis 5....

Pushing Glass (May 16, 2017)

A 15-year-old boy had a kidney biopsy because of the persistent nephrotic syndrome. His medical history is significant for resolved intermittent asthma. In late September 2016, he developed a viral syndrome with a runny nose, congestion, sore throat, vomiting, and diarrhea. Over the next one to two weeks, he developed generalized edema, most prominent in the lower extremities and belly. He was diagnosed presumptively with acute glomerulonephritis and treated accordingly. His condition continued to worsen with the persistent nephrotic syndrome and acute hypertension. Laboratory investigations show a serum creatinine of 1.35 mg/dL. Serum albumin is 1.9 g/dL. Urinalysis shows 3+...

Pushing Glass (March 22, 2017)

A 71-year-old woman with a history of multiple myeloma, hypertension and vitamin D deficiency presented with decreased renal function. Investigations show serum creatinine increased to 3.36 mg/dL. Serum albumin is 2.6 gm/dL. Twenty-four hour urinary protein is 2.8 gm/day. These images show characteristic findings of which of the following diseases: A) Thrombotic microangiopathy B) Cast nephropathy C) Light chain deposition disease D) Cryoglobulinemic glomerulonephritis E) Amyloidosis F) Fibrillary glomerulopathy Answer: D The images show intracapillary hyaline, thrombi which are weakly PAS-positive, and stain red on silver and trichrome stains. These showed positive staining only for IgG1 and kappa light chain....