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Disease Week: MGMID

Article
MGMID
Tuesday: Let's start with a poll. You have a 25-year-old female patient with a positive ANA and proteinuria.  On a kidney biopsy, light microscopy looks fairly unremarkable - a little mesangial expansion and mildly prominent capillary loops.  IF is also nearly unremarkable, but with 2+ C3 staining.  On EM, you have this finding. What do you do next? Stain the biopsy with PLA2R Perform IgG subclasses Do paraffin immunofluorescence There has to be a mix-up - check with the lab Answer - Paraffin Immunofluorescence   What do you expect to find by paraffin immunofluorescence? Strong C3 staining to confirm C3...
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Diagnose This (August 10, 2020)

Article
Tags: Collapsing GN, Nephrotic syndrome, APOL1, G1/G2, transplant, COVID-19, Diagnose This
What is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​ ​  ...
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Chronic Cyclosporine Toxicity in Pediatric Nephrotic Syndrome

Article
Pediatric Nephrotic Syndrome, childhood nephrotic syndrome, CSA, CNI, juxtaglomerular apparatus
This biopsy is from a 9-year-old boy who developed pediatric nephrotic syndrome in the first year of life and has been maintained on cyclosporine (CSA) due to frequent relapses. He had not had a biopsy before and was clinically on remission, considering switching to rituximab. The biopsy was performed to assess chronic changes and the presence of histologic signs of chronic calcineurin inhibitor (CNI) toxicity CNI toxicity. His serum creatinine was 0.6 mg/dL. He was also on lisinopril for proteinuria control. He was not hypertensive. The biopsy contained a total of 61 glomeruli, four of which were globally sclerotic. No...
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Art of Medicine: Minimal Change Disease

Article
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...
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Diagnose This (April 22, 2019)

Article
diffuse foot process effacement, Minimal change disease, Nephrotic syndrome, Podocytopathy, Arkana Laboratories
What is this finding and what diagnoses does it imply?       ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​    ...
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Twitter Poll (April 17, 2019)

Article
Collapsing Glomerulopathy, APOL1, arkana laboratories, kidney disease, renal pathology
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...
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Diagnose This (March 25, 2019)

Article
Nephrotic Syndrome, Arkana Laboratories, renal pathology, kidney injury
What is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​   ​ ​  ...
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IgA nephropathy with something extra…

Article
IgA nephropathy in renal biopsy from Arkana Laboratories
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...
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Diagnose This (October 29, 2018)

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