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A Case of an Unlucky Strike

This biopsy was from a 57-year-old African American female patient. She presented with a gradual increase in serum creatinine over the course of 5 months. Initially, her baseline serum creatinine was 1.3 mg/dl but two months later it increased to 2.0 mg/dl. And, at the time of the biopsy, an additional 3 months later, her serum creatinine was as high as 4.4 mg/dl. During her workup, she was found to have nephrotic syndrome with proteinuria quantified at 8 gm/24hr, a serum albumin of 1.3 g/dL, and ascites.  Concerning previous medical history, the patient had a diagnosis of stage II colon...

PLA2R Tutorial

The diagnosis of membranous glomerulopathy has been transformed in the past 10 years with the discovery of PLA2R. PLA2R is the most common target antigen in cases of primary membranous glomerulopathy. Immunohistochemical staining for PLA2R (shown here) can detect the PLA2R type of membranous with high sensitivity and specificity. Recent studies have shown that serum testing for PLA2R antibodies can serve as a useful biomarker for monitoring the clinical activity of this disease. 

Diagnose This! (May 14, 2018)

What is your diagnosis?    ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​ ​...

Pushing Glass (May 11, 2018)

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...

Arkanines: Tyler

Meet Tyler! He is an 11-year-old lab who is clearly a very accommodating big brother.  Tyler belongs to Ashley, who works in the lab. 

Chronic Lesions of ANCA – Arteritis

The renal biopsy shown here is from a patient with a remote history of ANCA-associated vasculitis. The artery present in these photomicrographs demonstrates the histopathology seen in remote arteritis including severe fibrosis and disruption of the media.

Chronic Active Antibody-Mediated Rejection

A diagnosis of chronic active antibody-mediated rejection (ABMR) requires morphologic evidence of chronic tissue injury (e.g. transplant glomerulopathy), evidence of current or recent antibody interaction with the vascular endothelium (e.g. linear C4d staining of peritubular capillaries), and serologic evidence of donor specific antibody (DSA) formation.  Importantly, the revised 2017 Banff classification of ABMR and T cell-mediated rejection (TCMR) recognizes C4d positivity as a substitute for DSA for diagnosing ABMR, although DSA testing is still strongly encouraged (see reference).  The images are from a patient with an elevated serum creatinine who had undergone living unrelated kidney transplant four years ago.  The...

Vascular-Limited AL Amyloidosis

A renal biopsy was performed on this 78 year old male with history of diabetes mellitus, hypertension and monoclonal gammopathy of undetermined significance (IgG kappa). The serum creatinine at presentation was 3.2 mg/dl and UPCR was 1.8 g/g.  The glomeruli diffusely show nodular mesangial expansion with segmental sclerosis and negative Congo red staining, consistent with diabetic glomerulosclerosis. On the other hand, the arteries and arterioles diffusely show deposition of a PAS pale, weakly argyrophilic, Congo red positive amorphous material which shows apple green birefringence upon polarization, consistent with amyloid deposits (Fig 1 and 2, Congo red). Similar deposits are not...