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Digging Deeper – Here, There, and Everywhere

This biopsy came from an elderly gentleman in his 80s, who presented with acute renal failure.  His serum creatinine had increased from a baseline of 1.3 mg/dL up to 6.6 mg/dL.  And in addition to that, urinalysis was positive for proteinuria and blood.  His medical history included pulmonary embolism, BPH, gastrointestinal hemorrhage and GERD.  Multiple serologies were ordered upon presentation, and among these, pANCA and MPO were markedly positive.  A biopsy was performed to investigate the possibility of an ANCA-mediated crescentic glomerulonephritis. Unfortunately, the material obtained for biopsy was small in size, and the longest core, submitted to light microscopy,...

Infection-Associated Glomerulonephritis

A 60-year-old male presents with a painful left hip, hematuria, and a creatinine of 1.5 mg/dl. He was recently hospitalized due to fever and chills. It was found that his left hip implant was infected. Blood cultures grew out methicillin-resistant Staphylococcus aureus. After beginning treatment with antibiotics and planning for surgery, a nephrology consult was requested. A kidney biopsy was performed and serologies were ordered. Figure 1 shows segmental endocapillary hypercellularity. Figure 2 shows mild interstitial fibrosis. Figure 3 shows staining with C3 only. All other immunofluorescence stains were negative on the frozen tissue. Immunofluorescence was then performed on the...

Arkana Physician Spotlight: Dr. Ambruzs

Dr. Josephine Ambruzs joined our staff in 2013 following the completion of her fellowship training in renal pathology at Arkana Laboratories. Dr. Ambruzs received her MD from Rutgers Robert Wood Johnson Medical School in Piscataway, NJ, a Master of Public Health in Epidemiology from the University of Alabama at Birmingham. She completed a pathology residency at the University of Texas Southwestern Medical Center, Dallas, TX, where she finished her tenure as chief resident. At Arkana, Dr. Ambruzs helps troubleshoot with our specimen triage team, works on our standardization in diagnostics committee, and provides much support as an internal consultant on...

KDIGO Connections: Membranous Glomerulopathy

Welcome to the first post in our new series KDIGO Connections, a series in which we are asking our nephrologist colleagues to educate us in real-world experiences treating kidney disease. In this series, Dr. David Bourne will be kicking it off with KDIGO guidelines for a kidney disease in visual abstract form. Our hope is that these posts will foster discussion regarding these diseases and how different providers approach them. Please share any points, pearls, questions, caveats, thoughts, or experience you have on the presented disease letting us all learn from your experience!  

Disease Week: Fibrillary Glomerulopathy

Fibrillary GN is a disease undergoing rapid change. In just ten years several clinical disease state associations have been defined, a new treatment paradigm has emerged, new diagnostic tests on renal biopsy have been discovered, and the beginnings of the molecular pathogenesis of the disease have been found. In the coming years, I hope continued research will help us answer a few important questions. First, no controlled, large scale, collaborative trials exist that prove treatment superiority in this disease and are sorely needed. Next, I hope that the discovery of DNAJB9 as a biomarker of this disease ignites a flurry...

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...

Introduction to Disease Week

Welcome to the first Disease Week! This is a monthly series led by a renal pathologist at Arkana with unique interest, experience, or expertise in a particular disease. Throughout Disease Week, you will see posts with links to useful research, as well as coordination between other series to showcase different facets of the disease. On Fridays of Disease Week, we will have a cumulative post of all the article links and a deeper dive into a topic for that disease. We want each Disease Week to educate as well as spark conversations about kidney diseases. Feel free to follow along on...

Uromodulin

Welcome to our first post in the Art of Medicine series! In the hustle and bustle of busy clinics, labs, and hospitals we are often focused on the practical aspects of the practice of medicine. Dr. Tiffany Caza is the content creator for this series as well as being a renal pathologist and artist. Her art focuses on her interpretations of the histologic, cellular, and sub-cellular milieu where a dazzling variety of chemical and structural forces inherent to all life exist. In this series, she will be sharing her art (and occasionally others) and providing correlates to the science represented...

IgA Dominant Infection-Associated Glomerulonephritis

A 65-year-old male presents to the ER with a new onset rash and blood in his urine. The ER doc is worried about an allergic reaction and on chem 7 finds that the patient’s creatinine is 6.5 mg/dl. The patient has been a diabetic for over 20 years and had been diagnosed with cellulitis of his left foot a week ago by a family practice physician who gave him antibiotics. A skin biopsy of the new onset rash during this hospitalization shows a leukocytoclastic vasculitis with IgA deposition. A kidney biopsy is requested. The kidney biopsy shows nodular diabetic glomerulosclerosis...

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