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Currently filtering by tag: Acute kidney injury

Digging Deeper – Here, There, and Everywhere

This biopsy came from an elderly gentleman in his 80s, who presented with acute renal failure.  His serum creatinine had increased from a baseline of 1.3 mg/dL up to 6.6 mg/dL.  And in addition to that, urinalysis was positive for proteinuria and blood.  His medical history included pulmonary embolism, BPH, gastrointestinal hemorrhage and GERD.  Multiple serologies were ordered upon presentation, and among these, pANCA and MPO were markedly positive.  A biopsy was performed to investigate the possibility of an ANCA-mediated crescentic glomerulonephritis. Unfortunately, the material obtained for biopsy was small in size, and the longest core, submitted to light microscopy,...

Infection-Associated Glomerulonephritis

A 60-year-old male presents with a painful left hip, hematuria, and a creatinine of 1.5 mg/dl. He was recently hospitalized due to fever and chills. It was found that his left hip implant was infected. Blood cultures grew out methicillin-resistant Staphylococcus aureus. After beginning treatment with antibiotics and planning for surgery, a nephrology consult was requested. A kidney biopsy was performed and serologies were ordered. Figure 1 shows segmental endocapillary hypercellularity. Figure 2 shows mild interstitial fibrosis. Figure 3 shows staining with C3 only. All other immunofluorescence stains were negative on the frozen tissue. Immunofluorescence was then performed on the...

IgA Dominant Infection-Associated Glomerulonephritis

A 65-year-old male presents to the ER with a new onset rash and blood in his urine. The ER doc is worried about an allergic reaction and on chem 7 finds that the patient’s creatinine is 6.5 mg/dl. The patient has been a diabetic for over 20 years and had been diagnosed with cellulitis of his left foot a week ago by a family practice physician who gave him antibiotics. A skin biopsy of the new onset rash during this hospitalization shows a leukocytoclastic vasculitis with IgA deposition. A kidney biopsy is requested. The kidney biopsy shows nodular diabetic glomerulosclerosis...

Diagnose This (December 10, 2018)

What is your diagnosis?           ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​  ...

Pushing Glass (December 7, 2018)

The patient is a 50-year-old female who presents 2 days after a renal transplant with a delay in graft function and a creatinine of 7. Her end-stage renal disease was due to diabetic glomerulopathy. She was on dialysis for 3 years. She received a kidney from a 22-year-old deceased donor (motorcycle accident). The kidney at time of transplant looked normal grossly and microscopically. What is the most likely cause of the patient’s delay in graft function? A. Acute Cellular Rejection B. Surgical manipulation of a vessel C. Recurrent diabetes D. Donor-derived disease   The correct answer is (B) surgical manipulation...

Diagnose This (December 3, 2018)

What is your diagnosis? What would you want to confirm your diagnosis?           ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​  ...

Twitter Poll (November 1, 2018)

ANSWER: D Drug-induced AIN may account for 60-70% of AIN cases. Some offending drugs include: antibiotics, proton pump inhibitors, NSAIDs, PD1-inhibitors, anti-convulsants, and diuretics, among others. References: Cortazar FB et al. Clinicopathological features of acute kidney injury associated with immune checkpoint inhibitors. Kidney Int 2016; 90: 638-47 Muriithi AK et al. Clinical characteristics, causes and outcomes of acute interstitial nephritis in the elderly. Kidney Int 2015; 87: 458-464. Muriithi AK et al. Biopsy-proven acute interstitial nephritis. Nat Rev Nephrol 2010; 6(8): 461-70 Praga M et al. Acute interstitial nephritis. Kidney Int 2010; 77(11): 956-61

Polyomavirus Nephropathy in Native Kidney

Polyomavirus nephropathy (PVN), predominantly caused by BK virus reactivation in the urogenital tract, is an important complication of renal allografts (reference 1). While it rarely affects the native kidney, it may be seen in the setting of chronic immunosuppression, including bone marrow transplantation, HIV infection, chemotherapy and in the setting of other solid organ transplants (reference 2). The case shown is from a 69-year-old female with a history of sarcoidosis and cirrhosis who is now 5 years post liver transplant. The patient is currently being evaluated for a progressive increase in serum creatinine. The biopsy shows significant, non-specific tubulointerstitial scarring...

Twitter Post (August 30, 2018)

ANSWER: B Type II (mixed) cryoglobulinemia is characterized by immune-complexes containing a monoclonal Ig (usually IgM) that have an RF activity and polyclonal Ig (usually IgG). It’s most commonly caused by HCV, with some cases caused by lymphoproliferative or autoimmune disorders. References: Zaidan M, et al. Spectrum and prognosis of noninfectious renal mixed cryoglobulinemic GN. J Am Soc Nephrol 2016; 27:1-12. Fabrizi F, et al. Hepatitis C virus infection, mixed cryoglobulinemia, and kidney disease. Am J Kidney Dis 2013; 61(4): 623-637.  

Differential Diagnosis of Kidney Injury in CLL/SLL Patients

There are many causes of decreased kidney function in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and a renal biopsy may provide a definitive diagnosis. Prerenal etiologies include poor oral intake, sepsis, and heart failure.  Intrarenal causes include diseases of the glomeruli (e.g. minimal change disease, MPGN pattern glomerulopathy, membranous glomerulopathy), tubules (e.g. toxic or ischemic tubular injury/necrosis, light chain cast nephropathy), interstitium (e.g. acute interstitial nephritis caused by infection or drugs), and vasculature (e.g. TMA).  The biopsy shown in this image illustrates infiltration of the kidney parenchyma by the lymphoid neoplasm (characteristic immunophenotypic studies not shown).  Postrenal causes...