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Pushing Glass (January 26, 2018)

Article
An otherwise asymptomatic 65-year-old man presents for medical evaluation after 15 years of not seeing a physician. He was noted to have an abnormal D-dimer test and was referred for further evaluation to the emergency department where his serum creatinine was found to be 5 mg/dL. Urinalysis showed 2+ proteinuria and 3+ blood. A renal biopsy was ordered. The images are characteristic findings of which of the following: 1. Amyloidosis 2. Fibrillary Glomerulopathy 3. Monoclonal immunoglobulin deposition disease 4. Dense Deposit Disease 5. Lupus nephritis 6. Anti-brush border antibody disease Choice 3 - Monoclonal immunoglobulin deposition disease (MIDD) is characterized...
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Diagnose This! (November 13, 2017)

Article
What is your diagnosis?     ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​...
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Light Chain Deposition Disease

Article
An elderly patient presents to nephrology for a rising creatinine. Baseline creatinine was 2.1 mg/dl six weeks prior but is now 3.4 mg/dl. He has poorly controlled diabetes and moderately well-controlled hypertension. Work up revealed a MGUS with positive IgG Lambda. Biopsy performed for kidney injury and to determine if there is a renal component related to his MGUS (r/o MGRS). Electron microscopy revealed only irregular electron densities along the tubular basement membranes. No powdery deposits were found. Diagnosis: Immunofluorescence Features Suggestive of Light Chain Deposition Disease, Lambda Light Chain Type Interstitial Fibrosis, Mild Arteriosclerosis, Severe   Follow Up: Bone...
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Light Chain Deposition Disease and Light Chain Proximal Tubulopathy

Article
An elderly but previously healthy patient presents with weakness and fatigue and was found to have a creatinine of 3.0 mg/dl. His baseline Cr was 1.2 mg/dl four months prior. No history of diabetes or hypertension. Biopsy performed for kidney injury, acute versus chronic. Tubular Injury, interstitial fibrosis, and intact glomeruli. 1. Tubular Injury, interstitial fibrosis, and intact glomeruli 2. Linear staining for lambda light chains along tubular basement membranes 3. Negative staining for kappa light chains along tubular basement membranes 4. Positive Lambda staining in tubular droplets 5. Negative Kappa staining in tubular droplets Electron microscopy was negative for...
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Diagnose This! (July 3, 2017)

Article
What’s your diagnosis?     ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​ ​...
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