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Twitter Poll (February 27, 2019)

Answer: B "Endocapillary hypercellularity" is the new term recommended to be used instead of "endocapillary proliferation". This is a more accurate term as an increase in cellularity can be the result of inflammatory influx and does not necessarily requires proliferation. Reference: Bajema IM, et al. Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int. 2018;93:789-796.    

Twitter Poll (February 20, 2019)

ANSWER: B The findings are suspicious for active antibody-mediated rejection (ABMR), based on the presence of moderate glomerulitis (g2), severe peritubular capillaritis (ptc3) and C4d staining in PTCs (C4d2). Serologic evidence of DSA is advised in order to meet the criteria for diagnosis. Reference: Haas M, et al. The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T-cell mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials. Am J Transplant. 2018; 1-15.

Twitter Poll (February 6, 2019)

Answer: B Minimal change disease is the most common glomerular disease associated with thymoma. Classically, the solid tumors most commonly associated with MN are lung, bronchus, and gastric cancers, followed by renal cell, prostate and thymoma. Other cancers reported with MN are colorectal, pancreatic, esophageal and hepatic carcinomas. References: Ronco PM. Paraneoplastic glomerulopathies: New insights into an old entity. Kidney Int 56: 355–377, 1999 Bacchetta J, Juillard L, et al. Paraneoplastic glomerular diseases and malignancies. Crit Rev Oncol Hematol 70: 39–58, 2009 Lefaucheur C, Stengel B, et al. Membranous nephropathy and cancer: Epidemiologic evidence and determinants of high-risk cancer association....

Twitter Poll (January 30, 2019)

ANSWER: B The medulla is the only compartment affected by AAPOAIV amyloidosis, sometimes with large amounts of amyloid. Glomeruli and vessels are spared and not affected by this type of amyloid. AAPOAIV Amyloidosis is a systemic amyloidosis reported from wild-type apolipoprotein AIV. When the kidney is involved the patient presents with gradual loss of renal function and proteinuria. It may also have cardiac involvement. References: Sethi S, Theis JD, Shiller SM, et al. Medullary amyloidosis associated with apolipoprotein A-IV deposition. Kidney Int 81: 201–206, 2012. Dasari S, Amin S, Kurtin P, et al. Clinical, biopsy, and mass spectrometry characteristics of...

Twitter Poll (January 16, 2019)

ANSWER: B The target of the circulating ABBA autoantibodies is LDL receptor-related protein 2 (LRP2) also known as “Megalin”. ABBA is a rare autoimmune disease associated with acute kidney injury and tubulointerstitial damage.  Histologically, IgG–positive immune deposits are found in tubular basement membranes by immunofluorescence (IF).  When indirect IF is done using patient’s serum and normal kidney controls, there is reaction of the autoantibodies with the proximal tubular brush borders. REFERENCE: Larsen CP, et al. LDL-Receptor Related Protein 2 (Megalin) as a Target Antigen in Human Kidney Anti-Brush Border Antibody Disease. J Am Soc Nephrol, 2018; 29:644-653    

Twitter Poll (January 9, 2019)

ANSWER: C DNAJB9 immunohistochemical (IHC) stain is a quick and inexpensive tool used to confirm the diagnosis of Fibrillary GN. DNAJB9 IHC has a sensitivity of 98% and >99% specificity.   In 2017, Dr. Nasr et al. discovered a novel proteomic biomarker for Fibrillary GN called DnaJ homolog subfamily B member 9 (DNAJB9), which is a member of the chaperone gene family. DNAJB9 immunohistochemical (IHC) stain is a quick and inexpensive tool used to confirm the diagnosis of Fibrillary GN. DNAJB9 IHC has a sensitivity of 98% and >99% specificity.   Reference: Nasr S, et al. DNAJB9 is a specific...

Twitter Poll (January 2, 2019)

ANSWER: B A reduced nephron number is associated with low birth weight, preterm birth, reduced kidney mass and size, short stature, maternal hyperglycemia, maternal protein malnutrition, and gene polymorphism for PAX2 and RET. References: Luyckx VA, Brenner BM. The clinical importance of nephron mass. J Am Soc Nephrolo 2010;21:898-910 Hughson M, Farris AB III, Douglas-Denton R, et al. Glomerular number and size in autopsy kidneys: the relationship to birth weight. Kidney Int 2003;63:2113

Twitter Poll (December 7, 2018)

ANSWER: D MGRS was introduced to acknowledge a clonal plasma cell or B lymphocyte proliferation causing a renal lesion in the absence of hematologic malignancy or other myeloma-defining events; the renal lesion is a consequence of the MIg, which carries major implications for management and prognosis, including the potential for progressive renal injury and ESRD. MGRS caused by PC is defined as <10% bone marrow plasma cells (BMPCs), <3 g/dl of M protein, and the presence of renal lesions without any other myeloma-defining events (CRAB features; clonal PC ≥60%; serum FLC ratio of ≥100; or >1 focal lesion on magnetic...

Twitter Poll (November 30, 2018)

ANSWER: D The cells of Goormaghtigh, AKA extraglomerular mesangial cells, lacis cells or Polkissen cells, are part of the juxtraglomerular apparatus. Ultrastructurally, these cells resemble mesangial cells. The lacis cells function as a physiologic liaison between the macula densa and arteriolar smooth muscle cells and the arteriolar granular myoepithelioid cells. They play an important role in renal autoregulation of blood flow to the kidney and regulation of systemic blood pressure through the renin-angiotensin system. References: Eknoyan G, Rubens R, Lameire R. The juxtaglomerular apparatus of Norbert Goormaghtigh – a critical appraisal. Nephrol Dial Transplant 2009; 24:3876-81. Christensen JA, Bohle A...

Twitter Poll (November 15, 2018)

ANSWER: A The number of nephrons in the normal kidney is important because they may play a role in the development of hypertension and progression of chronic renal disease. Nephron number is influenced by many factors that affect renal development. References: 1. Luyckx VA, Brenner BM. The clinical importance of nephron mass. J Am Soc Nephrolo 2010;21:898-910. 2. Bertram JF, Douglas-Denton R, et al. Human nephron