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Currently filtering by tag: Nephrotic syndrome

Art of Medicine: Minimal Change Disease

The above painting shows podocytes with foot processes extending along the glomerular basement membrane of neighboring capillary loops.  Effacement of podocyte foot processes occurs in primary podocytopathies, including minimal change disease (see electron photomicrograph below). Minimal change disease is the most common etiology of idiopathic nephrotic syndrome in children and is the third most common cause in adults, after focal segmental glomerulosclerosis and membranous glomerulopathy.  A majority of cases are “primary”, require no additional workup, and are due to a circulating permeability factor.   Several possible secondary causes have also been identified.  Although these are rare, these should be considered in...

Diagnose This (April 22, 2019)

What is this finding and what diagnoses does it imply?       ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​    ...

Twitter Poll (April 17, 2019)

ANSWER: D Collapsing glomerulopathy has been associated with certain infectious disease including HIV, Hepatitis C, HTLV-1, parvovirus B19, cytomegalovirus, tuberculosis, Campylobacter enteritis, and Loa loa filariasis. References: Cossey LN, Larsen CP, Liapis H. Collapsing glomerulopathy: a 30-year perspective and single, large center experience. Clin Kidney J 2017; 10(4):443-449 Cohen AH, Nast CC. HIV-associated nephropathy. A unique combined glomerular, tubular, and interstitial lesion. Mod Pathol 1988; 1: 87–97 D’Agati V, Suh JI, Carbone L, et al. Pathology of HIV-associated nephropathy: a detailed morphologic and comparative study. Kidney Int 1989; 35: 1358–1370 Pakasa NM, Nseka NM, Nyimi LM. Secondary collapsing glomerulopathy associated...

Diagnose This (March 25, 2019)

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

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...

Diagnose This (October 29, 2018)

What class of disease does this patient have and how did they present clinically?           ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​...

One little, two little, three little findings…

This biopsy came to us for evaluation of nephrotic syndrome. The patient is a Hispanic gentleman in his late 80s, with CKD stage IV and a history of arthritis, diabetes mellitus, coronary artery disease, and hypertension.  He had 4.9 g/g of proteinuria.  He had negative ANA, hepatitis B, and C serologies. C3 and C4 were within normal limits. Clinically, the differential diagnosis included membranous glomerulopathy and FSGS. The biopsy was a very good sample, consisting of long cores of renal tissue, mostly from cortex.  More than 20 glomeruli were present.  The glomeruli had clear features of diabetic nephropathy, as expected...

Membranoproliferative Glomerulonephritis Pattern

This glomerulus shows a membranoproliferative glomerulonephritis (MPGN) pattern of injury. To a large extent, the etiologic differential diagnosis depends on the immunofluorescence and ultrastructural findings. This light microscopic pattern of injury may be seen in one of the so-called C3 glomerulopathies, in MPGN with immune complexes (no known clinical cause), or in so-called "secondary" forms of MPGN in patients who have underlying infection, autoimmune disease, or dysproteinemia. Identifying the pattern of injury is only the beginning of the workup in many cases!

Diagnose This! (March 5, 2018)

What is the most likely diagnosis? For bonus points, what is the basic differential for this morphologic finding (non-immune and immune)?     ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​...

Diagnose This! (February 12, 2018)

What is your diagnosis? (Congo red is negative as is routine immunofluorescence)     ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​...