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Diagnose This (November 12, 2018)

What is your diagnosis and what do you need to prove it?           ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​  ...

IgA nephropathy with something extra…

The biopsy is from a 61-year-old man with a history of intermittent microscopic hematuria for many years who presents with recent 18-pound weight loss and nephrotic syndrome.  His creatinine is mildly elevated at 1.3 mg/dL.  He has 12.5 g of proteinuria and his serum albumin is 2.6 mg/dL.  The biopsy shows diffuse mild mesangial matrix expansion with no necrosis or proliferative lesions (Fig. 1).  Immunofluorescence microscopy shows extensive granular mesangial IgA deposits (3+) (Fig. 2), compatible with IgA nephropathy.  Interestingly, the Jones methenamine silver stain also shows argyrophilic spikes involving capillary loops, which are most suggestive of spicular amyloid deposits...

Diagnose This (November 5, 2018)

What renal state do these glomerular changes represent?    ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​  ...

Twitter Poll (November 1, 2018)

ANSWER: D Drug-induced AIN may account for 60-70% of AIN cases. Some offending drugs include: antibiotics, proton pump inhibitors, NSAIDs, PD1-inhibitors, anti-convulsants, and diuretics, among others. References: Cortazar FB et al. Clinicopathological features of acute kidney injury associated with immune checkpoint inhibitors. Kidney Int 2016; 90: 638-47 Muriithi AK et al. Clinical characteristics, causes and outcomes of acute interstitial nephritis in the elderly. Kidney Int 2015; 87: 458-464. Muriithi AK et al. Biopsy-proven acute interstitial nephritis. Nat Rev Nephrol 2010; 6(8): 461-70 Praga M et al. Acute interstitial nephritis. Kidney Int 2010; 77(11): 956-61

Diana Retirement

We said farewell this week as one of our long-time colleagues stepped into retirement bliss.  Here are a few words about Diana from her supervisor, Arkana Financial Manager, Neal Daugherty: On behalf of Arkana, I want to thank Diana for her conscientiousness and her hard-working service toward the company during the last eleven and half years.  Over that time, she has seen the company grow and mature and she responded to every challenge with courage and perseverance.  Personally, I appreciate the guidance she provided over my tenure with her and her graciousness as I learned Arkana.  She is truly a...

Infection-Associated Glomerulonephritis

This biopsy is taken from a 39-year-old woman who presents with abdominal pain, ascites, and lower extremity edema. Her serum creatinine is 3.9 mg/dL and her complete blood count shows leukocytosis (14,500). Initial serologic workup is negative. The biopsy shows a diffuse proliferative glomerulonephritis characterized by global endocapillary hypercellularity with prominent neutrophils, best visualized using methenamine silver staining (Fig. 1). No crescents, necrotizing lesions, or significant double contours are identified. By immunofluorescence, there is coarsely granular (3+) capillary wall and less prominent mesangial staining for IgG, C3, kappa, and lambda (Fig. 2). Electron microscopy shows global endocapillary proliferation and numerous...

Diagnose This (October 29, 2018)

What class of disease does this patient have and how did they present clinically?           ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​...

All in a day’s work

Less than a week until American Society of Nephrology's #kidneywk! This year we are asking what "All in a day's work" means to you.   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​...

How “omnioma” virus became “polyoma” virus…

The arrow points to an intranuclear viral inclusion characteristic of BK virus, one species of non-enveloped dsDNA viruses belonging to the polyoma virus family.  Sarah Stewart (see inset), a physician and research scientist, studied viral oncogenesis (she was the first woman to earn an M.D. degree from Georgetown Medical School).  Dr. Stewart and her collaborator, Dr. Bernice Eddy (Ph.D. virologist), renamed the parotid tumor virus originally discovered by Ludwik Gross “SE polyoma virus” (the “SE” was for “Stewart-Eddy”).  Interestingly, Dr. Stewart like the name “omnioma” virus, but Eddy suggested the term “polyoma” virus since not all viral infections caused tumors...