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Endocarditis-Associated Glomerulonephritis

Article
Endocarditis-Associated Glomerulonephritis, arkana laboratories, renal pathology teaching points
The patient is a 45-year-old IV drug user who presents with fevers, chills, hematuria, and fatigue. On laboratory testing, he was found to have a creatinine of 4.8. Complement levels are depressed and blood cultures are positive. A transesophageal echocardiogram confirmed the presence of endocarditis. A kidney biopsy was obtained due to hematuria. Image 1 and Image 3 shows circumferential cellular crescents with fibrinoid necrosis (many intracapillary neutrophils are seen in image 3). Figure 2 shows severe interstitial fibrosis. Images 4 and 5 show immunofluorescence staining with IgM and C3, respectively. This is a case of endocarditis-associated glomerulonephritis with diffuse...
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Diagnose This (June 24, 2019)

Article
ANCA-mediated glomerulonephritis, arkana laboratories, renal pathology, kidney biopsy
Immunofluorescence shows C3 (2-3+), IgM (1+), kappa (trace) and lambda (trace). What is your diagnosis?       ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​...
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Art of Medicine: ANCA-Associated Glomerulonephritis

Article
anca-associated-glomerulonephritis, art of medicine
The painting above shows a crescentic glomerulonephritis and necrotizing arteritis.  A mixed interstitial inflammatory infiltrate is shown in the top left corner, and tubules are dilated with a few red blood cell casts.  This cluster of findings can occur in ANCA-associated disease.  Renal biopsy images representing manifestations of ANCA-associated glomerulonephritis are shown below.  The main differential diagnosis for crescents within glomeruli includes immune complex glomerulonephritides, anti-GBM nephritis, and ANCA-associated glomerulonephritis (pauci-immune), although nearly any glomerulonephritis with mesangial and/or endocapillary proliferation can produce crescents (examples – infection-associated glomerulonephritis, fibrillary glomerulonephritis, and others).  Correlation with ANCA serologies is recommended in any case...
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Digging Deeper, or How We Never Quit

Article
Alport Syndrome, Digging Deeper, Arkana laboratories, renal pathology, kidney pathology, nephropathology
We received the biopsy from a 25-year-old female who presented for evaluation of nephrotic range proteinuria.  Lab evaluation reveals a creatinine of 0.55 and 24-hour urine protein is 3.6 g.  Serologies were negative or normal for ANA, hepatitis B, hepatitis C, HIV, and complement levels.  There was no history of hypertension or diabetes. A biopsy was performed to evaluate the source of proteinuria. Two cores of renal tissue were sampled on light microscopy evaluation.  They consisted mostly of medulla, and only two glomeruli were seen in multiple sections. The glomeruli have capillary loops with attenuated contours. The capillary loops appeared...
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Diagnose This (January 21, 2019)

Article
Anti-GBM, renal pathology , diagnose this!, arkana laboratories
A limited sample showed this lesion and negative staining on paraffin-retrieved IF tissue. What is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​...
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Digging Deeper – Here, There, and Everywhere

Article
ANCA, digging deeper, Dr. Messias, Arkana Laboratories, pathology diseases
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,...
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Diagnose This (December 3, 2018)

Article
What is your diagnosis? What would you want to confirm your diagnosis?           ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​  ...
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Diagnose This (August 20, 2018)

Article
What is your presumed diagnosis in the absence of immunofluorescence and electron microscopy?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​...
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Twitter Poll (July 18, 2018)

Article
ANSWER: D In a case series by Boils et al. which included 49 patients with GN due to IE, 28% of them had positive ANCA antibodies. Of note, in this study it was described that only 29 out of 49 patients had serology drawn for ANCA, 21 were negative (72%) and 8 (28%) were positive. Reference: Boils CL, et al. Update on endocarditis-associated glomerulonephritis. Kidney Int 2015; 87(6): 1241-1249.
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