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Arkanines: Abby

Arkanines Pets
Meet Abby! She's a 13-week-old Airedale Terrier. She loves squeaky toys and naps, but does not enjoy being woken up from said naps. She belongs to Christa, who is one of the cheerful voices you hear answer the phone here at Arkana.

Vascular Endothelial Growth Factor

The biopsy shown here is from a seven-year-old female with nephrotic syndrome. Her serum Cr was increased to 0.9 mg/dl and her urine protein/creatinine ratio was 7. She was s/p nephrectomy for renal cell carcinoma and had been treated with bevacizumab for six months prior to the biopsy. Serum C3 and C4 levels were normal and her platelet count was also normal. On biopsy, glomeruli show extensive basement membrane duplication and segmental hyalinosis of the glomerular tuft (arrow). These glomerular changes are characteristic of VEGF inhibitor-associated glomerulopathy. There is evidence to suggest that VEGF production by podocytes is required for...

Acute Pyelonephritis

The renal biopsy image shows features characteristic of acute pyelonephritis. There is a neutrophil-rich interstitial inflammatory infiltrate and evidence of acute tubular injury. Some tubular lumens are filled with neutrophils (arrow), and in some areas, neutrophils encircle the outer aspect of the tubules between the tubular basement membrane and the interstitium (arrowhead). In some cases, micro abscesses may even form (not shown). In most cases of ascending infection, large vessels and glomeruli are uninvolved. If arteritis or neutrophilic infiltrates involve glomeruli, the possibility of a hematogenous infectious source should be considered.

Client Spotlight: Drs. Fahim and Naeem Rahim

Drs. Rahim
This month our Arkana Client Spotlight is on the Drs. Fahim and Naeem Rahim! Drs. Fahim and Naeem Rahim started Idaho Kidney Institute in rural Southeastern Idaho after moving from New York in 2005. The goal was to provide state of the art care for patients suffering from kidney diseases, and also for those in need of kidney transplants or dialysis. Since then, Idaho Kidney has grown to become the largest provider of care for patients suffering from kidney disease, dialysis, and kidney transplants in Southeastern Idaho. Drs. Fahim and Naeem Rahim were recipients of the prestigious Ellis Island Medals of...

Diagnose This! (July 17, 2017)

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

BK Nephritis

This biopsy is from a patient with ESRD due to polycystic kidney disease. He is s/p deceased donor renal transplant 11 months prior to this biopsy. He was noted to have a steadily rising creatinine from baseline of 1.3 mg/dl up to 4.6 mg/dl at biopsy. Note the severe interstitial inflammation with nuclear atypia and severe arteriosclerosis (Figure 1, H&E 100x). There are markedly atypical nuclei including an apoptotic body (arrowhead) seen in the second image (Figure 2, 400x). The third image shows an SV40 IHC stain for polyoma virus that is positive in many nuclei (Figure 3, IHC SV40...

Endocarditis

Crescentic glomerulonephritis is most commonly an autoimmune-related glomerulonephritis (e.g. ANCA, anti-GBM disease, lupus nephritis). However, a recent case series (reference below) found that more than 50% of cases of endocarditis associated glomerulonephritis show a crescentic pattern of glomerulonephritis without endocapillary proliferation. Further, 28% of the patients with endocarditis-associated glomerulonephritis had positive serologic studies for ANCA. Therefore, it is important to maintain a high index of suspicion for infective endocarditis associated glomerulonephritis considering the potential adverse outcome if a patient with endocarditis was mistakenly treated for ANCA-associated glomerulonephritis with cytotoxic agents in lieu of antibiotics. Reference: Boils CL, Nasr SH, Walker...

Amyloid Casts

The differential diagnosis of acute renal failure in patients with multiple myeloma includes light chain cast nephropathy, amyloidosis, and monoclonal immunoglobulin deposition disease, among other possibilities. On occasion, patients with light chain cast nephropathy have large lamellated silver-positive casts with prominent peripheral spicules (Figure 1 and 2) instead of the more characteristic fractured and refractile PAS-negative casts. Such casts usually exhibit light chain restriction by immunofluorescence, and they have been designated in the literature as “intratubular amyloid” or “tubular amyloid casts” because they show congophilia and apple-green birefringence with polarized light (Figure 3). However, in the absence of glomerular, vascular,...