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Currently filtering by tag: Transplant

Diagnose This (August 10 ,2020)

Tags: Collapsing GN, Nephrotic syndrome, APOL1, G1/G2, transplant, COVID-19, Diagnose This
Q: What is your diagnosis?   The light microscopic image depicts a glomerulus with collapse of the capillary loops on the Jones methenamine silver stain. This lesion is identified by its prominent capillary loop collapse with overlying epithelial cell hyperplasia and hypertrophy, with associated protein resorption droplets. It is important to look at the background tubulointerstitium for findings that can be seen in association with this lesion such as increased proximal tubular resorption droplets, tubular microcystic tubular dilatation, and interstitial inflammation, as this lesion can be easily mistaken for crescent formation. Collapsing glomerulopathy can be seen as a primary (idiopathic)...

Twitter Poll (July 22, 2020)

Polyomavirus Nephropathy, Banff Class 3, Twitter Poll, Arkana Laboratories
ANSWER: C The answer is C, Polyomavirus Nephropathy, Banff Class 3. The Banff Working Group Classification was created by Nickeleit et al. to provide a classification scheme to aid communication, better standardize reporting of polyomavirus nephropathy, and provide a way for better comparative analysis of cases going forward. The classification is broken into three classes, Banff Class 1-3. This case highlights an example of a Polyomavirus Nephropathy, Banff Class 3 with a pvl score of 3 and ci (fibrosis) score of 2. Based on this score, the findings of the Banff working group showed that approximately 50% of these patients...

Twitter Poll (March 25, 2020)

twitter poll results, twitter analysis, quiz, arkana laboratories
  ANSWER: True In 2018, Nickeleit et al. postulated a morphologic classification of polyomavirus nephropathy (PVN) based on pathologic features that correlate with clinical outcomes. The study defines 3 morphologic PVN classes using interstitial fibrosis and intra-renal PV load levels as statistically verified class denominators. It describes class 1 as an early PVN stage with favorable outcome, and classes 2 and 3 as having more pronounced impact on function with graft failure rates reaching 50% in class 3. The proposed PVN classification aims at improving clinico-pathologic correlation and the comparability of studies: a simple biopsy diagnosis of "PVN" no longer...

Art of Medicine: The Pre-Implantation Kidney Biopsy

Pre-Implantation Kidney Biopsy
The painting above shows normal glomeruli, tubulointerstitium, and a normal artery from a pre-implantation wedge biopsy. Pre-implantation wedge biopsies, also known as donor biopsies, procurement biopsies, or harvest biopsies, are performed for extended criteria donor kidneys, high risk recovered donor kidneys, or at the request of the transplant surgeon, to evaluate for suitability for transplantation. Over 40% of procured kidneys are discarded prior to transplantation. The use of preimplantation kidney biopsies, performed as frozen sections at transplant centers, may reduce the discard rate by accepting kidneys that are histopathologically acceptable, as well as to avoid transplantation of sub-optimal organs. “Extended...

Twitter Poll (June 26, 2019)

TCMR, arkana laboratories, renal pathology, kidney biopsy
ANSWER: C Severe intimal arteritis (v2), with or without interstitial inflammation and/or tubulitis is considered acute TCMR Grade IIB based on the Banff 2017 classification. However, we now know that arterial lesions (v>0) may be indicative of ABMR, TCMR or mixed ABMR/TCMR and are not restricted to TCMR. Reference: Haas M, et al. The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T-cell mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials. Am J Transplant. 2018; 1-15.    

Membranous Nephropathy After Transplantation

Membranous Nephropathy, renal diseases, kidney biopsy, arkana laboratories
The biopsy shows a recurrent membranous nephropathy within a transplant. Figure 1 shows "spikes" and "holes." Figure 2 shows mild interstitial fibrosis. Figures 3, 4, 5, and 6 shows IgG, kappa, lambda, and PLA2r, respectively. Figure 7 shows subepithelial and intramembranous deposits. Membranous nephropathy can arise in the graft from recurrence of the original disease, a de novo disease, and rarely as a donor-derived disease. Recurrence of the original disease can be seen as early as one week post transplant. Most cases of recurrent membranous nephropathy occur within the first few months following transplantation, whereas de novo membranous nephropathy usually...

Pushing Glass (December 7, 2018)

surgical manipulation, pushing glass, arkana laboratories
The patient is a 50-year-old female who presents 2 days after a renal transplant with a delay in graft function and a creatinine of 7. Her end-stage renal disease was due to diabetic glomerulopathy. She was on dialysis for 3 years. She received a kidney from a 22-year-old deceased donor (motorcycle accident). The kidney at time of transplant looked normal grossly and microscopically. What is the most likely cause of the patient’s delay in graft function? A. Acute Cellular Rejection B. Surgical manipulation of a vessel C. Recurrent diabetes D. Donor-derived disease   The correct answer is (B) surgical manipulation...