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Archive: Miscellaneous

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...

Art of Medicine: Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits

Monoclonal Immunoglobulin Deposits
Small destructive B cell or plasma cell clones may be responsible for disease development. The above painting shows normal bone marrow, containing erythroid and myeloid precursors at various stages of maturation and normal trabeculae.   Bone marrow biopsies may be performed to evaluate for a lymphoid or plasma cell clone in patients with monoclonal gammopathies of undetermined significance (MGUS) and in work-up of patients found to have a monoclonal gammopathy of renal significance (MRGS).  Monoclonal gammopathies of renal significance occur when light chain restriction within a kidney biopsy is thought to be responsible for the patient's renal dysfunction, which is usually...

A Day in the Life of a Renal Pathologist

Renal Path, Renal Pathologist, Dr. Joel Murphy, Dr. Nich Cossey
8:30-10:00am: I get to work and have some coffee. For most physicians, this time of day is devoted to research, reading & writing, teaching conferences or even dropping the kids off at school. As the Physician Chief at Arkana, my mornings are usually filled with meetings. My meetings typically are with members of the physician team who have areas of responsibility they oversee or with the content team where we create all the content you see on Arkana’s Twitter/Facebook and Blog. One day a week I try to devote this time to my research projects.  10:00-11:00am: I attend our daily case conference...

Membranous Lupus Nephritis

The patient is a 19-year-old female who presents with hematuria, nephrotic range proteinuria, and a creatinine of 1.2 mg/dL. She has a recent diagnosis of systemic lupus erythematosus. Figure 1 shows a normal glomerulus without "spikes" and "holes" of the glomerular basement membranes. Figure 2 shows no significant interstitial fibrosis. Figures 3, 4, 5, & 6 shows IgG, kappa, lambda, and C1q respectively. Image 7 and 8 shows subepithelial deposits. This is a case of membranous lupus nephritis (ISN/RPS Class V). By definition, no proliferative changes (crescents, fibrinoid necrosis, endocapillary hypercellularity) are seen within the glomeruli in a pure class...

Vascular Resistance

The sampled artery in this kidney biopsy shows severe arteriosclerosis.  The deleterious effects of a narrowed arterial lumen and increased stiffness of the artery wall are illustrated mathematically:  resistance to blood flow is directly proportional to vessel length and blood viscosity and inversely proportional to vessel diameter (or radius).  This formula illustrates how vessel diameter (or radius) has the most profound effect on resistance, especially since vessel length and blood viscosity do not usually change significantly in most physiologic states.