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VEGF Inhibitor

The patient is a 70-year-old white female who presents with 4 gm/24 hr proteinuria and a creatinine of 1.2 mg/dl. She has colon cancer with metastases to the liver, treated with chemotherapy and Avastin. The patient has recently had anemia, thrombocytopenia, ascites, and a urinary tract infection treated with nitrofurantoin. Her blood pressure has been under good control at 120/80. Figure 1 shows acellular closure of the capillary lumens and a "cotton-candy" appearance of the mesangium. Figures 2 and 3 shows capillary microaneurysms and segmental capillary hyalinosis. Figure 3 additionally shows double contours. Figure 4 shows moderate interstitial fibrosis. Figure...

Art of Medicine: Lupus Nephritis

The above painting shows features of a proliferative glomerulonephritis.  Endocapillary proliferation, crescent formation, and segmental sclerosis is shown.   These findings can be seen in focal or diffuse lupus nephritis, but are not specific, as they can be identified in other proliferative glomerulonephritides, such as IgA nephropathy, infection-associated glomerulonephritis, and others. Immunofluorescence studies can help in distinguishing lupus nephritis from other forms of proliferative glomerulonephritis, as there is typically a "full house" pattern with expression of all 3 immunoglobulin heavy chains (IgA, IgM, IgG), and complement (C3, C1q), as shown below. Classification of lupus nephritis is through the International Society of...

Pi Day 2019

We had our 2nd Annual Pi Day Contest! It's our most delicious competition. Congratulations to this year's winners: Savory - Aaron (bacon, andouille sausage, and gruyere quiche) Sweet - Tie between Angela (key lime pie) and Amber (pumpkin pie)  

Disase Week: Collagen Type III Glomerulopathy

Collagen type III glomerulopathy is an ultra-rare kidney disease of unknown etiology and pathogenesis with only rare cases reported in the literature, the vast majority being case reports. A few non-controlled, small case series exist that shed light on differences in pediatric and adult presentations and specific geographic patient populations. Type III collagen is typically absent in normal glomeruli, although small amounts have been reported in some advanced glomerular diseases. In patients with collagen type III glomerulopathy, abundant type III collagen is seen within the mesangium and lamina rara interna of the capillary loops and typically occurs in a flocculent...

Twitter Poll (March 7, 2019)

ANSWER: True The presence of multiple exostoses due to mutation of the EXT1 gene has been described in a family. There are few isolated reports of extrarenal involvement in patients with type III collagen glomerulopathy, suggesting that the renal lesion may be part of systemic disease in some patients.  References: Cohen AH. Collagen Type III Glomerulopathies. Adv Chronic Kidney Dis. 2012;19(2):101-6. Roberts IS, Gleadle JM. Familial nephropathy and multiple exostoses with exostosin-1 (EXT1) gene mutation. J Am Soc Nephrol. 2008;19:450-453    

Art of Medicine: ANCA-Associated Glomerulonephritis

The painting above shows a crescentic glomerulonephritis and necrotizing arteritis.  A mixed interstitial inflammatory infiltrate is shown in the top left corner, and tubules are dilated with a few red blood cell casts.  This cluster of findings can occur in ANCA-associated disease.  Renal biopsy images representing manifestations of ANCA-associated glomerulonephritis are shown below.  The main differential diagnosis for crescents within glomeruli includes immune complex glomerulonephritides, anti-GBM nephritis, and ANCA-associated glomerulonephritis (pauci-immune), although nearly any glomerulonephritis with mesangial and/or endocapillary proliferation can produce crescents (examples – infection-associated glomerulonephritis, fibrillary glomerulonephritis, and others).  Correlation with ANCA serologies is recommended in any case...

Ehop Visit

This week two of our favorite Ehop coaches were in town for a quick visit.  It's always a treat to spend time for them and be encouraged on our wellness journeys!    

Twitter Poll (February 27, 2019)

Answer: B "Endocapillary hypercellularity" is the new term recommended to be used instead of "endocapillary proliferation". This is a more accurate term as an increase in cellularity can be the result of inflammatory influx and does not necessarily requires proliferation. Reference: Bajema IM, et al. Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int. 2018;93:789-796.