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Currently filtering by tag: IgA nephropathy

Twitter Poll (April 9, 2020)

twitter poll answer for april 9
  ANSWER: C In one of the largest cases series by Ambruz et al., IgAN was the most common diagnosis (24%) observed in patients with IBD, followed by interstitial nephritis (19%), arterionephrosclerosis (12%), ATI (8%), proliferative GN (7%) and minimal change disease (5%).   References: Ambruzs JM, Walker PD and Larsen CP. The Histopathologic Spectrum of Kidney Biopsies in Patients with Inflammatory Bowel Disease. Clin J Am Soc Nephrol 2014; 9:265-270. Ambruzs JM, Larsen CP. Renal Manifestations of Inflammatory Bowel Disease. Rheum Dis Clin N Am 2018; 44 (4):699-714

Disease Week: Infection-Associated Glomerulonephritis and Endocarditis-Associated Glomerulonephritis

Infection-Associated Glomerulonephritis and Endocarditis-Associated Glomerulonephritis, Disease Week, Arkana Laboratories
Monday Renal disease related to infective endocarditis was first reported over 100 years ago. However, the initial literature describing nephritis associated with infective endocarditis relied primarily on autopsy-based studies from the pre- and early post-antibiotic era.  Reviews from recent decades note the evolution in renal complications of infectious diseases. Demographics have changed from younger to older patients. The frequency of comorbidities including diabetes has increased.  Recent decades have seen a change in the infectious agents that cause renal disease, from primarily Streptococcal to a broader array of organisms compared to the past, with predominance of Staphylococci. The historical division into...

Art of Medicine: IgA Nephropathy

IgA Nephropathy
The above painting shows glomeruli with mesangial hypercellularity, endocapillary hypercellularity, and crescent formation.  These findings can be seen in IgA nephropathy, and other active glomerulonephritides.  These lesions shown in the painting above are represented in the Oxford Classification for IgA nephropathy.  The Oxford classification is a scoring system on kidney biopsies that  includes mesangial hypercellularity (M0 = <50%, M1 = >50%), endocapillary hypercellularity (E0 = none, E1 = present), segmental sclerosis (S0 = absent, S1 = present), tubular atrophy / interstitial fibrosis (T0 = <25%, T1 25-50%, T2 >50%), and crescents (C0 = absent, C1 = up to 25%, C2...

Twitter Poll (May 22, 2019)

IgA nephropathy, Twitter Poll, Arkana Laboratories, kidney pathology, renal disease
ANSWER: C By the Oxford Classification of IgA nephropathy, the findings present are classified as "M1 E1 S1 T1 C0" (where M=Mesangial hypercellularity; E=Endocapillary proliferation; S=Segmental sclerosis; T=Tubular atrophy & interstitial fibrosis; C=Cellular/fibrocellular crescents). REFERENCE: Trimarchi H, et al. Oxford Classification of IgA Nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int 2017; 91(5):1014-21.    

Crescentic IgA nephropathy

IgA, Crescentic IgA Nephropathy, chronic kidney disease, Arkana Laboratories
The patient is a 17-year-old white female who presents with 2.85 grams/24 hr proteinuria, microscopic hematuria, and a creatinine of 3.2 mg/dl. She was in her normal state of health and was incidentally found to have abnormal lab values and urinalysis at a routine sport's physical. She reports that she had noticed a little more fatigue the last few months, but had blamed this on being busy at her job after school. Figure 1 shows focal fibrinoid necrosis. Figure 2 shows moderate tubular atrophy and interstitial fibrosis. Figures 3 & 4 show a segmental cellular crescent. Figure 5 shows several...

Disease Week: Renal Manifestations of Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease, IBD, renal disease, chronic kidney disease, renal biopsy, Arkana Laboratories
Monday Extraintestinal manifestations of inflammatory bowel disease are common and involve nearly every organ system. Renal and urinary involvement has been reported to occur in 4% to 23% of inflammatory bowel disease patients manifested primarily as urinary calculi, fistulas, and ureteral obstruction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725142/ https://www.ncbi.nlm.nih.gov/pubmed/?term=pardi+AND+renal+and+urologic+complications Parenchymal renal disease is rare but has been well documented in the form of case reports and small series describing glomerulonephritis, minimal change disease, secondary amyloidosis, and tubulointerstitial nephritis. https://www.ncbi.nlm.nih.gov/pubmed/12722045 https://www.gastrojournal.org/article/S0016-5085(02)00276-7/fulltext Renal biopsy is not frequently performed on patients with IBD, though it should be considered in patients presenting with renal insufficiency, proteinuria, or hematuria, particularly...

Twitter Poll (April 3, 2019)

IgAN & Inflammatory Bowel Disease, Igan, arkana laboratories, renal pathology, nephropathology, chronic kidney disease
ANSWER: C IgAN is the most frequent diagnosis seen in kidney biopsies from patients with renal failure and history of inflammatory bowel disease. In a retrospective study performed by Ambruzs et al., the prevalence of IgAN was 24%, followed by TIN (19%), arterionephrosclerosis, ATI, proliferative GN and MCD. Reference: Ambruzs JM, et al. The histopathologic spectrum of kidney biopsies in patients with inflammatory bowel disease. 2014 Clin J Am Soc Nephrol; 9(2):265-270.

IgA nephropathy with something extra…

The biopsy is from a 61-year-old man with a history of intermittent microscopic hematuria for many years who presents with recent 18-pound weight loss and nephrotic syndrome.  His creatinine is mildly elevated at 1.3 mg/dL.  He has 12.5 g of proteinuria and his serum albumin is 2.6 mg/dL.  The biopsy shows diffuse mild mesangial matrix expansion with no necrosis or proliferative lesions (Fig. 1).  Immunofluorescence microscopy shows extensive granular mesangial IgA deposits (3+) (Fig. 2), compatible with IgA nephropathy.  Interestingly, the Jones methenamine silver stain also shows argyrophilic spikes involving capillary loops, which are most suggestive of spicular amyloid deposits...