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This biopsy is taken from a patient with HIV/AIDS who presented with an elevated serum creatinine and nephrotic range proteinuria.  Key morphologic features associated with HIV-related kidney disease include collapsing glomerular lesions, microcystic tubular dilatation and variable tubular epithelial injury, and interstitial inflammation and edema (see Fig 1-3).  In addition to these findings, other kidney diseases seen in patients with HIV include the following:  HIV immune complex kidney disease (HIVICK), various other immune complex diseases (e.g. hepatitis C virus, membranous glomerulopathy), HIV-associated lupus-like glomerulonephritis, thrombotic microangiopathy, and various renal tumors (e.g. Kaposi sarcoma, lymphoma).

Diabetic Glomerulosclerosis with Superimposed Diseases

Diabetic glomerulosclerosis is one of the most common causes of nephrotic range proteinuria in adults. When the clinical course of these patients is atypical, a renal biopsy is of utmost importance to rule out superimposed or other concomitant diseases. Figure 1 (PAS stain) shows a representative glomerulus from a renal biopsy performed on a 65 year old Caucasian female with longstanding history of type 2 diabetes mellitus, who experienced a sudden increase in proteinuria from a baseline UPCR of 1.2 g/g to 7.5 g/g. The glomerulus shows severe mesangial matrix expansion with frequent large nodule formation, characteristic of diabetic glomerulosclerosis....

Client Spotlight: Terri Munson

This month we would like to shine our Client Spotlight on Terri Munson, Histotechnologist at UnityPoint Health-Methodist in Peoria. Recently, Terri came into work on Saturday and found that a renal biopsy had missed the FedEx pickup on Friday. Rather than have it wait until Monday to be sent out, she contacted us to see if anything could be done to prevent it from being delayed further. FedEx was unable to pick up the specimen, so Terri offered to go above and beyond for the patient and drove the specimen to a local FedEx station so it could be sent...

Diagnose This (July 16, 2018)

What is your diagnosis in this native kidney biopsy? And for bonus points, what do you suspect is the underlying etiology of the diagnosis?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​...

New Fellows

Our new fellows started this week! Meet Dr. Zeljko Dvanajscak and Dr. Tiffany Caza. Dr. Z is cheering for Croatia today as they play in the World Cup.  We kind of love them both already. 

Peritubular Giant Cells

When giant cells surround tubules… This renal biopsy was taken from a young woman with an elevated serum creatinine (4.3 mg/dL), hematuria, and proteinuria. By light microscopy, there is a prominent giant cell reaction surrounding many of the tubules (Fig 1), the differential diagnosis of which includes so-called giant cell tubulitis (a form of tubulointerstitial nephritis associated with tubular basement membrane immune complex deposits), lupus tubulointerstitial nephritis, and monoclonal immunoglobulin deposition disease. By immunofluorescence, there is intense positivity of the tubular and glomerular basement membranes for kappa light chain (3+) with no corresponding staining for lambda light chain (Fig 2-3)....

Diagnose This (July 9, 2018)

What is your diagnosis in this native kidney biopsy?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​...

Chronic Lesions of ANCA – Fibrous Crescent

Fibrous crescents can be differentiated from ischemic obsolescent glomeruli based on the pattern of global sclerosis. The fibrous crescent has interruption of the sclerotic glomerular tuft by fibrosis as is shown in photomicrograph A. By comparison, the ischemic obsolescent glomerulus in photomicrograph B shows a retracted glomerular tuft surrounded (but not transected by) fibrosis.

Hemoglobin Casts

This 58-year-old African American male without significant past medical history presents with fatigue and weakness. During workup, he was found to have anemia, mild thrombocytopenia, elevated LDH, low haptoglobin and acute kidney injury. The serum creatinine at presentation was 5.5 mg/dl. A renal biopsy was performed and shows acute tubular injury with numerous granular and globular eosinophilic (Fig 1) and fuchsinophilic casts (Fig 2) within the tubular lumens. A myoglobin immunoperoxidase stain is negative (not shown) and a hemoglobin stain is diffusely positive within the pigmented casts. Otherwise, the glomeruli and vessels appear normal, without evidence of microangiopathy. These findings...