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Disease Week: Infection-Associated Glomerulonephritis and Endocarditis-Associated Glomerulonephritis

A paradigm shift has occurred in the epidemiology, bacteriology, and clinical and pathologic findings of infection-associated glomerulonephritis over the past few decades.  The incidence of acute Streptococcal glomerulonephritis has declined, in part due to improved socioeconomic conditions and the advent of antibiotic therapy in developed countries.  An increase in methicillin-resistant and sensitive Staphylococcal infections ranging from superficial skin infections to deep-seated occult infections such as visceral abscess, osteomyelitis, and endocarditis has been noted.  This increase is seen in the expanding elderly population who have increasing comorbidities of diabetes and heart disease and increased use of cardiac devices, indwelling catheters and...

Fellowing Joel: Episode 4

[video width="1920" height="1080" mp4=""][/video] This week we caught Dr. Murphy while learning our EM process.    

Fellowing Joel: Episode 3

[video width="1920" height="1080" mp4=""][/video] It's Friday, and we caught up with Dr. Murphy to see what he has been learning all week! The kidney art on the screen as illustrated by the talented Dr. Stephen Bonsib.    

Twitter Poll (September 26, 2019)

ANSWER: C APOL1-risk alleles have been reported only on African-derived chromosomes, including individuals from West Africa and recently admixed individuals from the United States or the Caribbean. Approximately 13% of the US African American population carries the APOL1 high-risk genotype. Recent data suggest that this risk is strongly associated with two common variants (G1 and G2) in the last exon of APOL1 that confer resistance to Trypanosoma brucei infections. The highest G1 and G2 allelic frequencies were described in Western, sub-Saharan Africa, with frequencies >40% for G1 in Ghana and Nigeria, and 24% for G2 in Nigeria. REFERENCES: Parsa A, Kao WHL, Xie D,...

Art of Medicine: Monoclonal Gammopathies of Renal Significance

The above painting is of a bone marrow biopsy showing replacement of the hematopoietic elements with plasma cells, including atypical plasma cells (Mott cells and plasma cells with Dutcher bodies shown).  This can be seen in plasma cell myeloma.   Multiple myeloma can be diagnosed with the presence of a plasma cell myeloma (>10% clonal bone marrow plasma cells), and one or more myeloma-defining events.  These include hypercalcemia, renal insufficiency, anemia, or lytic lesions within bones.   On a kidney biopsy, light chain cast nephropathy is a myeloma defining event and is a paraprotein-associated renal disease.  Other renal manifestations that can occur...

ALECT2 Amyloidosis

The patient is a 75-year-old Hispanic male who presents with progressively worsening kidney function and a creatinine of 1.6 mg/dl (baseline 1.0 mg/dl). His physician called for a biopsy due to a slowly "creeping" creatinine over the last 8 months. Images 1 & 2 show "apple-green birefringence" on a Congo red stain under polarized light within the interstitium. Image 3 shows mild interstitial fibrosis. Image 4 shows a normal glomerulus on PAS stain and Image 5 shows positive immunohistochemical staining with Lect2. Leukocyte cell-derived chemotaxin 2 (ALECT2) amyloidosis preferentially affects Hispanics (particularly Mexicans) as well as Punjabis, First Nations people...

Fellowing Joel: Episode 2

Today is Friday! That means it's time to see what our renal fellow, Dr. Murphy, has been learning. [video width="1920" height="1080" mp4=""][/video]    

Clinical Trials: Why Are They Important?

At Arkana Laboratories we are actively engaged in a variety of research areas, including clinical trials in which we currently assist in a variety of on-going trials from numerous pharmaceutical companies.  My name is Clint Abner, and I manage clinical trials and contract research here at Arkana. Clinical trials are essential to disease research for finding new medications, treatments, and even cures for disease.  They are designed to answer questions that lead to improved health and quality of life for patients.  They can show researchers what does and does not work in humans, and often generate data that cannot be...