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Twitter Poll (June 13, 2019)

ANSWER: D The use of anticoagulant therapy (warfarin, dabigatran, rivaroxaban, among others) can result in AKI by causing glomerular hemorrhage and renal tubular obstruction by RBC casts. This may be a serious potential complication especially in older patients with underlying chronic kidney injury. References: Glassock RJ. Anticoagulant-Related Nephropathy It's the Real McCoy. CJASN 14:935-937, 2019. Brodsky S, Eikelboom J, Hebert LA. Anticouagulant-Related Nephropathy. J Am Soc Nephrol 29:2787-2793, 2018. Brodsky S, Satoskar A, et al. Acute Kidney Injury During Warfarin Therapy Associated with Obstructive Tubular Red blood Cell Casts: A Report of Nine Cases.  Am J Kidney Dis 54(6):1121-6, 2009....

Twitter Poll (April 17, 2019)

ANSWER: D Collapsing glomerulopathy has been associated with certain infectious disease including HIV, Hepatitis C, HTLV-1, parvovirus B19, cytomegalovirus, tuberculosis, Campylobacter enteritis, and Loa loa filariasis. References: Cossey LN, Larsen CP, Liapis H. Collapsing glomerulopathy: a 30-year perspective and single, large center experience. Clin Kidney J 2017; 10(4):443-449 Cohen AH, Nast CC. HIV-associated nephropathy. A unique combined glomerular, tubular, and interstitial lesion. Mod Pathol 1988; 1: 87–97 D’Agati V, Suh JI, Carbone L, et al. Pathology of HIV-associated nephropathy: a detailed morphologic and comparative study. Kidney Int 1989; 35: 1358–1370 Pakasa NM, Nseka NM, Nyimi LM. Secondary collapsing glomerulopathy associated...

Twitter Poll (April 3, 2019)

ANSWER: C IgAN is the most frequent diagnosis seen in kidney biopsies from patients with renal failure and history of IBD. In a retrospective study performed by Ambruzs et al., the prevalence of IgAN was 24%, followed by TIN (19%), arterionephrosclerosis, ATI, proliferative GN and MCD. Reference: Ambruzs JM, et al. The histopathologic spectrum of kidney biopsies in patients with inflammatory bowel disease. 2014 Clin J Am Soc Nephrol; 9(2):265-270.

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