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Currently filtering by tag: Acute tubular injury

Twitter Poll (November 25, 2020)

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twitter poll, calcium oxalate, renal pathology, arkana laboratories
Answer: B Ethylene glycol toxicity due to oral ingestion classically shows acute tubular injury characterized by epithelial simplification, loss of brush border, vacuolization, and reactive nuclear changes in association with intratubular calcium oxalate deposition. Of note, these crystals are polarizable whereas calcium phosphate crystals are not.  
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Hemosiderosis

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renal hemosiderosis, arkana laboratories, teaching point, renal pathology
An 80-year-old white male presents with a creatinine of 4.2 (baseline 1.1) on routine lab examination. His medical history is significant for coronary artery disease, aortic valve replacement, hypertension, and peripheral artery disease. He reports no episodes of dehydration and reports that he has been in his normal state of health. Figure 1 shows a normal glomerulus. Figure 2 shows a mild interstitial fibrosis. Figure 3 shows brown spherules within the tubular epithelial cells. Figure 4 confirms the presence of iron within these brown spherules. This is a case of renal hemosiderosis. The presence of iron deposits speaks towards intravascular...
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Diagnose This (February 25, 2019)

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kappa light chain, diagnose this, arkana laboratories, renal pathology
What is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​ ​  ...
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Renal Oxalosis

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Renal oxalosis, arkana laboratories, teaching point at arkana Laboratories, renal pathology
A 25-year-old female presents to the hospital with malaise and a creatinine of 3.5. She reports that she was in her normal state of health until about 2 weeks ago when she had the “flu.” The patient has minimal proteinuria and bland urine sediment. A kidney biopsy was obtained. Figure 1 shows a normal glomerulus. Figure 2 shows severe chronicity. Figure 3 and 4 show polyhedral clear crystals within the tubular lumina. Figure 5 shows an increased number of oxalate crystals under polarized light. Renal oxalosis is characterized by excess deposition of calcium oxalate crystals within the kidney. There are...
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Step By Step

Article
ANCA, digging deeper, Dr. Messias, Arkana Laboratories, pathology diseases
The biopsy is from a 65 year-old female who presented with acute renal failure and elevated creatinine up to 1.9 mg/dl.  She has non-ischemic cardiomyopathy and protein electrophoresis is positive for lambda light chains.  Serologies for ANA and rheumatoid factor are within normal limits.  A biopsy was performed to rule out paraprotein associated disease and there was a specific concern for amyloidosis, due to cardiac changes. The biopsy consisted of a good sample, contained multiple cores of tissue and more than 20 glomeruli.   The glomeruli were very unremarkable by light microscopy – loops were open, with regular contours, and no...
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Diagnose This (November 19, 2018)

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What is your diagnosis? What additional stains would you like to confirm your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​...
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Twitter Poll (September 26, 2018)

Article
ANSWER: D Hall’s stain is used to confirm the presence of bile casts. This technique uses the oxidizing action of Fouchet’s reagent to convert the bile pigment (bilirubin) into an easily identifiable green color (biliverdin). Bile pigments appear green against a yellow background. The color ranges from olive green to emerald green, depending upon the concentration of bilirubin. REFERENCES: Hall MJ. A staining reaction for bilirubin in sections of tissue. Amer J Clin Path, 1960; 34:313-316. Luna LG. Manual of Histologic Staining Methods of the Armed Forces Institute of Pathology, 3rd ed., McGraw-Hill, N.Y., c. 1968, p.174. van Slambrouck CM,...
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Diagnose This (July 16, 2018)

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What is your diagnosis in this native kidney biopsy? And for bonus points, what do you suspect is the underlying etiology of the diagnosis?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​...
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Hemoglobin Casts

Article
This 58-year-old African American male without significant past medical history presents with fatigue and weakness. During workup, he was found to have anemia, mild thrombocytopenia, elevated LDH, low haptoglobin and acute kidney injury. The serum creatinine at presentation was 5.5 mg/dl. A renal biopsy was performed and shows acute tubular injury with numerous granular and globular eosinophilic (Fig 1) and fuchsinophilic casts (Fig 2) within the tubular lumens. A myoglobin immunoperoxidase stain is negative (not shown) and a hemoglobin stain is diffusely positive within the pigmented casts. Otherwise, the glomeruli and vessels appear normal, without evidence of microangiopathy. These findings...
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