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Diagnose This (August 10 ,2020)

Tags: Collapsing GN, Nephrotic syndrome, APOL1, G1/G2, transplant, COVID-19, Diagnose This
Q: What is your diagnosis?   The light microscopic image depicts a glomerulus with collapse of the capillary loops on the Jones methenamine silver stain. This lesion is identified by its prominent capillary loop collapse with overlying epithelial cell hyperplasia and hypertrophy, with associated protein resorption droplets. It is important to look at the background tubulointerstitium for findings that can be seen in association with this lesion such as increased proximal tubular resorption droplets, tubular microcystic tubular dilatation, and interstitial inflammation, as this lesion can be easily mistaken for crescent formation. Collapsing glomerulopathy can be seen as a primary (idiopathic)...

Twitter Poll (August 5, 2020)

Nail-Patella syndrome, Twitter Poll, Arkana Laboratories
Answer: A, Autosomal recessive inheritance Nail-Patella syndrome is a rare autosomal dominant disease with an incidence of approximately 1/50,000. The majority of cases are due to a mutation in LMX1B located at chromosome 9q34.1. The gene is important in development as it encodes a transcription factor important in dorsoventral pattern limb development, proper development of the anterior eye, neuron development within the CNS, and podocyte differentiation and maintenance. The kidney pathology is rather non-specific and can show minimal glomerular changes to variable degrees of FSGS with thickened capillary loops. By EM, the classic finding is that of "Moth-eaten" glomerular basement...

MYMP Alert!

collapsing glomerulopathy, Caza and Larsen, COVID-19, MYMP, Arkana Labs
Our MYMP made a special appearance today! Dr. Caza and Dr. Larsen teamed up with Dr. Velez to discuss the re-emergence of collapsing glomerulopathy with COVID-19. Read the paper: COVAN is the new HIVAN: the re-emergence of collapsing glomerulopathy with COVID-19 Stay on the lookout for the next MYMP sighting!  

Diagnose This (August 3 ,2020)

Fibrillary Glomerulopathy, Diagnose This!, Arkana Laboratories, pathology, nephropathology, renal pathology
Q: What is your leading diagnosis when seeing this interesting IgG staining pattern by IF?   The immunofluorescence shows a glomerulus with a very characteristic "smudgy" pattern of staining with IgG within the mesangium and along the capillary loops characteristic of Fibrillary Glomerulopathy. Fibrillary GN is an extremely rare disease, seen in <1% of native kidney biopsies and is caused by the deposition of fibrillar deposits of immunoglobulin within the mesangium with extension into the glomerular capillary loops. By electron microscopy, the fibrils are characterized as non-branching, randomly arranged, and have an average diameter of approximately 20 nm (range: 10-30...

Twitter Poll (July 22, 2020)

Polyomavirus Nephropathy, Banff Class 3, Twitter Poll, Arkana Laboratories
ANSWER: C The answer is C, Polyomavirus Nephropathy, Banff Class 3. The Banff Working Group Classification was created by Nickeleit et al. to provide a classification scheme to aid communication, better standardize reporting of polyomavirus nephropathy, and provide a way for better comparative analysis of cases going forward. The classification is broken into three classes, Banff Class 1-3. This case highlights an example of a Polyomavirus Nephropathy, Banff Class 3 with a pvl score of 3 and ci (fibrosis) score of 2. Based on this score, the findings of the Banff working group showed that approximately 50% of these patients...

Communication in the Time of Covid

communication in times of covid, arkana voices, arkana laboratories, human resources
I have seen many variations of a particular meme but they all say basically the same thing “Oh how I miss 'precedented' times…they were the best!” But here we are, in very UNprecedented times, that have brought unique challenges to the world of human resources. The passage of the FFCRA and CARES acts in response to the novel coronavirus have brought with them a slew of changes, both immediate and evolving. Many agencies such as the Department of Labor, OSHA, ERISA and the CDC have issued their guidance and interpretations of such hastily enacted legislation and the ever-shifting understanding of...

Chronic Cyclosporine Toxicity in Pediatric Nephrotic Syndrome

Pediatric Nephrotic Syndrome, childhood nephrotic syndrome, CSA, CNI, juxtaglomerular apparatus
This biopsy is from a 9-year-old boy who developed pediatric nephrotic syndrome in the first year of life and has been maintained on cyclosporine (CSA) due to frequent relapses. He had not had a biopsy before and was clinically on remission, considering switching to rituximab. The biopsy was performed to assess chronic changes and the presence of histologic signs of chronic calcineurin inhibitor (CNI) toxicity CNI toxicity. His serum creatinine was 0.6 mg/dL. He was also on lisinopril for proteinuria control. He was not hypertensive. The biopsy contained a total of 61 glomeruli, four of which were globally sclerotic. No...

The MYMP Has Been Caught!

Dr. Best, MYMP, Detection of SARS-CoV-2, publication, arkana laboratories, arkana visualized
Dr. Best has caught the MYMP! Along with Dr. Larsen, Dr. Sharma, Dr. Caza, and Dr. Kuperman, Dr. Best recently published a paper covering the detection of SARS-CoV-2 in formalin-fixed paraffin. Read the paper: Detection of SARS-CoV-2 in Formalin-Fixed Paraffin-Embedded Tissue Sections Using Commercially Available Reagents Who will catch the MYMP next?

Diagnose This (July 13,2020)

Fabry's disease, myelosomes, zebra bodies, X linked disease
What is your diagnosis?   The electron microscopic image depicts a podocyte with numerous myeloid bodies, myelinosomes, or "zebra" bodies as they are also known. This finding, taken in concert with the patient's clinical history was compatible with Fabry's disease. By light microscopy, a characteristic finding is the lacy, or foamy cytoplasm of the podocytes due to the lipid inclusions composed of globotriaosylceramide. Additionally, toluidine blue sections can be extremely helpful in identifying these inclusions. Fabry's disease is classified as a lysosomal storage disease caused by a deficiency in the alpha-galactosidase, an enzyme leading to the accumulation of globotriaosylceramide (GL3)...

Twitter Poll (July 8, 2020)

Twitter Poll, Deficiency of adenine phosphoribosyltransferase , APRT, Arkana Laboratories
ANSWER: D Renal oxalosis is a progressive tubulointerstitial disease which can be primary or secondary in nature. Specifically, secondary causes can be due to increased ingestion or absorption of sources of oxalate, decreased excretion, and certain vitamin imbalances. Oxalosis secondary to ingestion can occur with ingestion of oxalate containing foods such as rhubarb, spinach, peanuts, tea, starfruit, and ethylene glycol poisoning, among others. Increased absorption of oxalate containing substances occurs in maladaptive states such as after gastric/intestinal bypass surgery, prolonged antibiotic use, Crohn's disease, pancreatic insufficiency, and in short bowel syndrome. Other causes of oxalosis would include hypervitaminosis C, vitamin...