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Currently filtering by tag: Proteinuria

Diagnose This (August 24, 2021)

Amyloidosis, AA amyloid, IV drug, proteinuria
This is the biopsy of a 32yo IV drug user who has nephrotic range proteinuria and MSSA bacteremia secondary to a skin abscess. What is this stain and what is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​  ...

Disease Week: MGMID

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...

Diagnose This (November 16, 2020)

glomerulomegaly, arkana laboratories, renal pathology, diagnose this, kidney pathology
  What conditions would be in your differential diagnosis for this finding? (Hint: large glomerulus)       ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​...

Diagnose This (November 2, 2020)

Alport Syndrome, Arkana Laboratories, diagnose this, renal pathology, kindey path, kidney disease
What is this finding? In a young male patient with hematuria and hearing loss, what would be your top diagnosis?       ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​  ...

Twitter Poll (September 16, 2020)

Fibrillary glomerulonephritis, arkana laboratories, twitter poll
Answer: C Fibrillary glomerulonephritis is a rare disease affecting less than 1% of all native kidney biopsies and is due to fibrillary deposits of immunoglobulin that by electron microscopy are randomly arranged fibrils of approximately 18-20 nm in diameter. Clinically patients will present with proteinuria and hematuria. Histologically it can show several patterns within glomeruli including mesangial proliferative, membranoproliferative, or even a crescentic pattern of glomerular injury. Positive staining with the DNAJB9 stain is extremely useful in identifying this disease as it is around 98% sensitive and 99% specific for Fibrillary GN. Associations with Fibrillary GN include autoimmune disease, infection...

Membranous Lupus Nephritis

Membranous Lupus Nephritis, arkana laboratories, renal pathology, kidney biopsy
The patient is a 19-year-old female who presents with hematuria, nephrotic range proteinuria, and a creatinine of 1.2 mg/dL. She has a recent diagnosis of systemic lupus erythematosus. Figure 1 shows a normal glomerulus without "spikes" and "holes" of the glomerular basement membranes. Figure 2 shows no significant interstitial fibrosis. Figures 3, 4, 5, & 6 shows IgG, kappa, lambda, and C1q respectively. Image 7 and 8 shows subepithelial deposits. This is a case of membranous lupus nephritis (ISN/RPS Class V). By definition, no proliferative changes (crescents, fibrinoid necrosis, endocapillary hypercellularity) are seen within the glomeruli in a pure class...

Art of Medicine: Collapsing Glomerulopathy

Collapsing Glomerulopathy
The above painting shows a glomerulus with capillary tuft collapse, visceral epithelial cell hyperplasia, and numerous protein resorption droplets within Bowman’s space; findings that can be seen in collapsing glomerulopathy.  A PAS stain from a case of collapsing glomerulopathy is also shown in the photomicrograph below.  Initially, collapsing glomerulopathy was considered a severe form of focal segmental glomerulosclerosis and placed into the Columbia classification. According to the Columbia classification, collapse of at least one capillary loop with obliteration of the lumen and proliferation and hypertrophy of overlying podocytes is sufficient for a diagnosis of the collapsing glomerulopathy.  Tubulointerstitial damage is...

Art of Medicine: Diabetic Nephropathy

Diabetic Nephropathy, Art of Medicine
The above painting shows glomeruli with nodular mesangial expansion and arterial hyalinosis, changes frequently seen in diabetic nephropathy. Diabetic nephropathy is graded by the classification system established by the Renal Pathology Society to separate lesions into varying degrees of severity. In class I diabetic glomerulopathy, there are no changes identified by light microscopy, but thickening of the glomerular basement membranes are seen on electron microscopy (see photomicrograph below). Thickened glomerular basement membranes are greater than 471 nm in women or 520 nm in men (in our lab), which represents greater than 2 standard deviations above the normal population. Glomerular basement...