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Live Kidney Pathology Series – May 2020

May 2020 Kidney pathology series, Arkana Laboratories
  Join us for our first Live Kidney Pathology Series!   May 23 | 10-11am CDT   Dr. Patrick Walker will present "Introduction to Kidney Pathology."  Moderated by Dr. Matt Sparks and Dr. Samira Farouk.    Register here:          

Diagnose This (May 18 ,2020)

Diagnose This!, anti-Coagulation
The light microscopic image demonstrates acute tubular injury with numerous occlusive red blood cell casts, which, despite obtaining deeper levels, is out of proportion to the degree of glomerular injury. While a few glomeruli showed occasional red blood cells within Bowman's space, there was no evidence of overt glomerular injury or activity such as cellular crescent formation, fibrinoid necrosis, or endocapillary hypercellularity. Thus, while it is a non-specific finding, this degree of red blood cell casts without glomerular proliferation should raise the pathologist's suspicion for anti-coagulation induced nephropathy. It is essential for the pathologists to probe further into not only...

Twitter Poll (May 6, 2020)

  ANSWER: A Bleeding is the most common and clinically relevant complication after a kidney biopsy. Studies from 1970s and 1980s have shown radiologic (CT) evidence of bleeding in 57%-91% of patients, depending on the use of older scanners, biopsy techniques, and needles. References: Hogan JJ, Mocanu M and Berns JS. The Native Kidney Biopsy: Update and Evidence for Best Practice. Clin J Am Soc Nephrol 11: 354-362, 2016. Ralls PW, Barakos JA, Kaptein EM, Friedman PE, et al. Renal biopsy-related hemorrhage: Frequency and comparison of CT and sonography. J Comput Assist tomog 11: 1031-1034, 1987. Alter AJ, Zimmerman S,...

Diagnose This (April 27 ,2020)

myoglobin cast, diagnose this
The microscopic image shows an H/E stain at high power of tubules displaying proximal tubular injury with epithelial thinning, reactive nuclear change, and intratubular, eosinophilic pigmented casts with a globular to beaded/ropey appearance. When casts with this morphology are found, the next step is to identify if the nature of the cast, including myoglobin and hemoglobin. In this case, the casts stained strongly for myoglobin, which fit clinically as the patient was suffering from rhabdomyolysis secondary to statin use. Aside from drugs, the clinical differential diagnosis for rhabdomyolysis includes physical trauma (i.e. intense exercise, seizure), toxins (i.e. snake venom), inflammatory...

Fellowing Joel- Episode 22

Fellowing Joel, Joel Murphy, Renal Pathology
They grow up so fast! Nearing the end of his fellowship, Dr. Murphy begins taking on more responsibility as well as more cases. [video width="1920" height="1080" mp4=""][/video]

Twitter Poll (April 22, 2020)

Twitter Poll results for EXT1/EXT2
  ANSWER: A A recent study published by Sethi et al. demonstrated the presence of two proteins, Exostosin1 (EXT1) and Exostosin 2 (EXT2), along the GBM of PLA2R-negative MN. In this study, the authors showed that 81% of the EXT1/EXT2-associated MN showed features of autoimmune disease, including membranous lupus nephritis.   Reference: Sethi S, et al. Exostosin1/Exostosin 2-Associated Membranous Nephropathy. JASN 2019; 30:1123-1136.

Diagnose This (April 20 ,2020)

TMAF pathology report, Diagnose This!, Arkana Laboratories
What is your diagnosis and possible differential for the finding?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​...

Art of Medicine: Alport Syndrome- A Review of Ultrastructural Abnormalities

The above painting depicts electron microscopy of a case of Alport syndrome.   Alport syndrome is a type of hereditary nephritis due to mutations in the alpha 3, alpha 4, or alpha 5 chains of collagen type IV.   As a result, the typical alpha 3-4-5 meshwork of type IV collagen in the GBM is replaced by an alpha 1-2 meshwork, which has less tensile strength and has susceptibility to proteolysis by matrix metalloproteinases (Zeisberg et al, 2006). Patients with Alport syndrome present with hematuria and progressive renal failure, and males are disproportionately affected.  Deafness and visual problems can also occur.  Kidney...

Twitter Poll (April 9, 2020)

twitter poll answer for april 9
  ANSWER: C In one of the largest cases series by Ambruz et al., IgAN was the most common diagnosis (24%) observed in patients with IBD, followed by interstitial nephritis (19%), arterionephrosclerosis (12%), ATI (8%), proliferative GN (7%) and minimal change disease (5%).   References: Ambruzs JM, Walker PD and Larsen CP. The Histopathologic Spectrum of Kidney Biopsies in Patients with Inflammatory Bowel Disease. Clin J Am Soc Nephrol 2014; 9:265-270. Ambruzs JM, Larsen CP. Renal Manifestations of Inflammatory Bowel Disease. Rheum Dis Clin N Am 2018; 44 (4):699-714

Fellowing Joel- Episode 21

Fellowing Joel, Joel Murphy, Renal Pathology
See how Dr. Murphy has been keeping busy during the quarantine on Fellowing Joel- Episode 21! He also shares a message to all the first responders, doctors, nurses, and others fighting on the front lines of COVID-19. Special appearance by Aida! And thanks to Kristen for filming this for us. [video width="1920" height="1080" mp4=""][/video]