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Diagnose This! (June 5, 2017)

What’s your diagnosis?     ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​ ​...

Arkana Physician Spotlight: L. Nich Cossey, MD

Dr. Cossey joined us in 2013 after completing his fellowship training in renal pathology at Arkana Laboratories. Dr. Cossey received his MD and completed his pathology residency at the University of Arkansas for Medical Sciences, Little Rock, AR. Away from the microscope, you can often find Dr. Cossey helping our IT team problem solve, coordinating our conferences, and developing our social media strategies.  Dr. Cossey’s favorite quote is “The surest way to corrupt a youth is to instruct him to hold in higher esteem those who think alike than those who think differently." (Friedrich Nietzsche-The Dawn; sec. 297) Here at...

Chronic Active Tubulointerstitial Nephritis

39 y/o male presents with acute kidney injury, creatinine 3.5 mg/dl. Bland urinalysis, serologic studies negative. Immunofluorescence study of the renal biopsy was negative for all stains. EM showed no deposits and was otherwise unremarkable. 1. Tubulointerstitial nephritis (H&E x100). 2. Lymphocytes, plasma cells, neutrophils and eosinophils (H&E x400). 3. Interstitial inflammation and fibrosis (Trichrome x100) 4. Intact glomerulus (PAS x400). Diagnosis: Chronic Active Tubulointerstitial Nephritis Comment: Most likely drug-induced but other causes include Sjogren’s syndrome, tubulointerstitial nephritis with uveitis (TINU), Behcet’s syndrome, sarcoid among others. Further discussion with the clinician after giving the above pathologic diagnosis: “Oh, that fits...

Fabry EM

Electron photomicrograph of a glomerular podocyte showing the characteristic electron dense laminated inclusions of Fabry disease. Fabry is a lysosomal storage disease with X-linked inheritance. Mutations in the gene for the enzyme alpha galactosidase A (GLA) result in accumulation of a glycolipid known as globotriaosylceramide (GL-3) in tissues including the kidney.

Congo Red Stain

The ability to detect amyloid deposits in human tissue is the critical first step in making a diagnosis of amyloidosis. David P. Steensma, MD, offers readers a fascinating history of the Congo red stain (see references), which still remains the most widely used and cost-effective way to identify amyloid deposits in pathology specimens. Although reportedly first used to stain human tissue in 1886 (see H. Greisbach), it would not be until 1922 that the dye’s specificity for amyloid would be exploited (see H. Bennhold). And it would be another five years before the well-known “apple-green” birefringence of Congo red-stained amyloid deposits...

Chef Boyardaniel

Chef Boyardaniel is perfecting his cookie recipe* because at this year's River Cities Dragon Boat Festival we are having a bake sale! We'll have various baked goods for sale with all proceeds benefiting the Children's Protection Center- Little Rock, AR. June 17! Come see us! (We totally bought these delicious cookies from Kris & Sam's The Box Lunch and Cookie Store)

Pushing Glass (May 30, 2017)

A 62-year-old Asian male with a past medical history significant for ESRD secondary to hypertension S/P renal transplant (9 months ago) presents with a creatinine of 1.9 (baseline 1.2). The patient has had no previous episodes of rejection. The donor-specific antibody is negative. CMV, adenovirus and BK serology is pending. What is the best diagnosis? A. Acute Cellular Rejection, Banff Type 1B B. BK Nephritis C. Adenovirus D. Acute Antibody-Mediated Rejection The correct answer is B (BK nephritis). The low power trichrome picture shows patchy interstitial inflammation and fibrosis. The glomerulus has thickened capillary walls, but no definitive double contours...

Diffuse Mesangial Hypercellularity

This biopsy is from a previously healthy 3 year old female, who presented with sudden onset nephrotic syndrome, hypertension and microscopic hematuria. Light microscopy shows greater than 4 cells per mesangial region in most glomeruli (Fig 1), with absence of segmental glomerulosclerosis. Immunofluorescence is completely negative and electron microscopy shows diffuse epithelial foot process effacement (Fig 2). The findings are consistent with minimal change disease with diffuse mesangial hypercellularity. This pattern of injury is considered a variant of minimal change disease. Patients with diffuse mesangial hypercellularity have a higher risk of initial resistance to steroid therapy; however, it is not...

Light Chain Cast Nephropathy

Immunofluorescence staining with kappa light chain and lambda light chain antibodies shows negative kappa in casts that are lambda positive in serial section. Monoclonal light chain staining in atypical casts is characteristic of light chain cast nephropathy (LCCN). In this case, a monoclonal lambda clone is responsible though kappa light chains are the more common cause with a 3 to 1 predominance. These casts are not only tubulotoxic but are also obstructive.