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Diagnose This (March 30,2020)

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What is the name of this rare finding typically seen in the outer medulla? ​   ​ ​   ​ ​   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​...

Twitter Poll (March 25, 2020)

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  ANSWER: True In 2018, Nickeleit et al. postulated a morphologic classification of polyomavirus nephropathy (PVN) based on pathologic features that correlate with clinical outcomes. The study defines 3 morphologic PVN classes using interstitial fibrosis and intra-renal PV load levels as statistically verified class denominators. It describes class 1 as an early PVN stage with favorable outcome, and classes 2 and 3 as having more pronounced impact on function with graft failure rates reaching 50% in class 3. The proposed PVN classification aims at improving clinico-pathologic correlation and the comparability of studies: a simple biopsy diagnosis of "PVN" no longer...

Twitter Poll (March 18, 2020)

ANSWER: B Membranous glomerulonephritis (MGN) is the most commonly described glomerular disease in IgG4-related disease. MGN was present in about 7% of cases of IgG4-related tubulointerstitial nephritis from two biopsy series studies.   Other specific glomerular diseases have been reported in patients with IgG4-related disease, including IgA nephropathy/Henoch Schönlein purpura nephritis, membranoproliferative glomerulonephritis (MPGN), and mesangioproliferative immune complex glomerulonephritis.   References: Alexander MP, et al. Membranous glomerulonephritis is a manifestation of IgG4-related disease. Kidney Int 2013; 83:455-462. Saeki T, et al. Membranous nephropathy associated with IgG4-related systemic disease and without autoimmune pancreatitis. Clin Nephrol 2009; 71:173-178. Morimoto J, et al....

Diagnose This (March 16,2020)

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

Fellowing Joel- Episode 19

Fellowing Joel, Joel Murphy, Renal Pathology
After a few weeks of travel and sickness, we finally got a chance to catch up with Dr. Murphy! [video width="1280" height="720" mp4=""][/video]  

Art of Medicine: Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits

Small destructive B cell or plasma cell clones may be responsible for disease development. The above painting shows normal bone marrow, containing erythroid and myeloid precursors at various stages of maturation and normal trabeculae.   Bone marrow biopsies may be performed to evaluate for a lymphoid or plasma cell clone in patients with monoclonal gammopathies of undetermined significance (MGUS) and in work-up of patients found to have a monoclonal gammopathy of renal significance (MRGS).  Monoclonal gammopathies of renal significance occur when light chain restriction within a kidney biopsy is thought to be responsible for the patient's renal dysfunction, which is usually...

Common Misconceptions in Renal Pathology

Misconception #1: Renal Pathology is Too Hard The truth is that renal pathology can be more complicated than other areas of pathology because it is a clinicopathologic field and to practice it well you need to have a good grasp of certain clinical topics in nephrology. Of course, in pathology residency, you don't get any exposure to nephrology so every pathologist that tries to learn renal pathology is handicapped until they gain sufficient clinical knowledge to utilize in interpreting the patterns they see on biopsy. For our fellows, this process usually takes a few months before they gain confidence. Renal...

Diagnose This (February 24, 2020)

Purple microscopic image demonstrating multiple large, polarizable intratubular crystals characteristic of calcium oxalate.
The light microscopic image demonstrates multiple large, polarizable intratubular crystals characteristic of calcium oxalate. While an occasional calcium oxalate crystal is not uncommon to see in renal biopsies, especially in patients with chronic kidney disease, this case demonstrated numerous crystals throughout the sample consistent with a diagnosis of renal oxalosis. Renal oxalosis is typically a progressive tubulointerstitial disease (although can occur acutely) with many causes which can be classified as secondary to increased ingestion, increased absorption, decreased excretion, or vitamin deficiency. Increased enteric absorption of oxalate occurs secondary to malabsorptive states such as gastric/intestinal bypass surgery (as seen in this...

Fellowing Joel- Episode 16

Fellowing Joel, Joel Murphy, Renal Pathology
This week we caught up with Dr. Murphy as he put the finishing touches on his ABBA presentation for USCAP 2020! [video width="1920" height="1080" mp4=""][/video]

Twitter Poll (February 19, 2020)

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ANSWER: C The Oxford IgAN Classification takes in consideration the percentage of interstitial fibrosis and tubular atrophy (T) as one of the histologic findings to predict outcome, irrespective of treatment. T0 represents <25%, T1 26-50% and T2 >50% cortical involvement. REFERENCES: 1. Trimarchi et al. Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int 2017; 91(5):1014-1021. 2. Haas et al. A multicenter study of the predictive value of crescents in IgA nephropathy. J Am Soc Nephrol 2017; 28:691-701.