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Archive: Twitter Poll

Twitter Poll (March 25, 2020)

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  ANSWER: True In 2018, Nickeleit et al. postulated a morphologic classification of polyomavirus nephropathy (PVN) based on pathologic features that correlate with clinical outcomes. The study defines 3 morphologic PVN classes using interstitial fibrosis and intra-renal PV load levels as statistically verified class denominators. It describes class 1 as an early PVN stage with favorable outcome, and classes 2 and 3 as having more pronounced impact on function with graft failure rates reaching 50% in class 3. The proposed PVN classification aims at improving clinico-pathologic correlation and the comparability of studies: a simple biopsy diagnosis of "PVN" no longer...

Twitter Poll (March 18, 2020)

ANSWER: B Membranous glomerulonephritis (MGN) is the most commonly described glomerular disease in IgG4-related disease. MGN was present in about 7% of cases of IgG4-related tubulointerstitial nephritis from two biopsy series studies.   Other specific glomerular diseases have been reported in patients with IgG4-related disease, including IgA nephropathy/Henoch Schönlein purpura nephritis, membranoproliferative glomerulonephritis (MPGN), and mesangioproliferative immune complex glomerulonephritis.   References: Alexander MP, et al. Membranous glomerulonephritis is a manifestation of IgG4-related disease. Kidney Int 2013; 83:455-462. Saeki T, et al. Membranous nephropathy associated with IgG4-related systemic disease and without autoimmune pancreatitis. Clin Nephrol 2009; 71:173-178. Morimoto J, et al....

Twitter Poll (February 19, 2020)

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ANSWER: C The Oxford IgAN Classification takes in consideration the percentage of interstitial fibrosis and tubular atrophy (T) as one of the histologic findings to predict outcome, irrespective of treatment. T0 represents <25%, T1 26-50% and T2 >50% cortical involvement. REFERENCES: 1. Trimarchi et al. Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int 2017; 91(5):1014-1021. 2. Haas et al. A multicenter study of the predictive value of crescents in IgA nephropathy. J Am Soc Nephrol 2017; 28:691-701.

Twitter Poll (February 12th)

Answer: C Transplant glomerulopathy (TG) is characterized by duplication of glomerular basement membrane (GBM) and is graded based on the percentage of glomerular capillary loops with GBM duplication or double contours in the most affected non-sclerotic glomerulus by LM. TG often indicates the presence of chronic antibody mediated rejection, for which there will be glomerulitis (B), C4d positivity in PTCs (C), and mesangial matrix increase (A).  These findings are not in isolation from one another, therefore, "all of the above" would also be a correct answer. The Banff Lesion Score cg is based on the presence and extent of GBM double...

Twitter Poll (February 5, 2020)

ANSWER: D 2,8-dihydroxyadeninuria (DHA) disease is a rare autosomal recessive disorder caused by complete adenine phosphoribosyltransferase (APRT) deficiency and manifests as recurrent nephrolithiasis. 2,8-DHA can lead to irreversible renal failure and frequently recurs in the transplants. For the blog: Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive inherited disorder of purine metabolism. APRT catalyzes the formation of adenosine monophosphate from adenine. In the absence of APRT activity, adenine is catabolized by xanthine oxidase to 2,8-dihydroxyadenine (DHA), which is excreted in the urine. DHA is insoluble in the urine at the physiological range of pH, which may lead to crystalluria....

Twitter Poll (December 11, 2019)

Answer: D Anti-GBM disease presents with rapidly progressive glomerulonephritis (GN) with or without pulmonary hemorrhage. On biopsy typical disease displays bright polytypic linear GBM staining for IgG by immunofluorescence and diffuse crescentic/necrotizing GN on light microscopy. Anti-glomerular basement membrane (GBM) nephritis is clinically and pathologically one of the most aggressive form of glomerulonephritis. Patients typically present with nephritic syndrome and rapidly progressive acute kidney injury. Lung involvement in the form of alveolar hemorrhage occurs in 34% to 62% of patients. Anti-GBM disease is due to circulating autoantibodies directed against cryptic epitopes in the NC1 domain of the alpha-3 chain of...

Twitter Poll: October 30, 2019

ANSWER: D ADPKD is genetically heterogeneous with two major genes, PKD1 and PKD2 (~90% families), and a rare third locus, GANAB lately discovered. Less than 10% of ADPKD families are negative for these genes. More recently, DNAJB11 has been identified in those patients from ADPKD-negative pedigrees. For the blog: ADPKD is the most common inherited kidney disorder. Two genes PKD1 and PKD2, coding for membrane proteins involved in the primary cilium, account for more than 90% of typical cases of ADPKD. A third gene, GANAB coding for the α-subunit of the endoplasmic reticulum-resident enzyme glucosidase II, has been associated with...

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,...

Twitter Poll (September 12, 2019)

ANSWER: B In a case series by Boils et al. which included 49 patients with GN due to IE, the most common biopsy finding was necrotizing and crescentic GN which was found in 53% of the cases. This was followed by endocapillary proliferative GN in 37% of the biopsies. Reference: Boils CL, et al. Update on endocarditis-associated glomerulonephritis. Kidney Int. 2015; 87(6):1241-1249.  

Twitter Poll (August 28, 2019)

ANSWER: A Dr. Albert Hewett Coons was an American physician, pathologist, and immunologist who conceptualized and developed the immunofluorescence technique for labeling antibodies in the early 1940s. Renal pathologists acquired this technique for the assessment of medical kidney biopsies, and since then it has become the gold standard on routine evaluation. References: Coons, AH, et al. The demonstration of pneumococcal antigen in tissues by the use of fluorescent antibody. J Immunol 1942; 45: 159-170. Coons, AH. The beginnings of immunofluorescence. J Immunol 1961; 97: 499-503.