Bx for nephrotic syndrome in an IV drug user with multiple infections. LM was all medulla, but good enough to make a diagnosis. AA amyloidosis; very common bx result in this clinical setting. #renalpath #pathsky #nephsky

A startling biopsy. Severe acute TMA in a pt with suspected scleroderma renal crisis. Massive vascular thrombosis, mucoid intimal edema, and early onion skin change associated with severe cortical necrosis. #renalpath #nephsky #pathsky

Interesting case of AL-amyloidosis. Massive vascular deposits, even in hilar arterioles with glomerular sparring. Patient had minimal proteinuria given lack of glomerular amyloid. #renalpath #pathsky #nephsky

Kidney txp biopsy with histologic features of acute pyelonephritis. Neutrophilic tubulitis, neutrophilic casts, and tubules which seem to explode out. Cellular rejection typically is not neutrophilic and inflammation hits the tubules from the outside in. #renalpath #nephsky #pathsky

AJKD Atlas of Renal Pathology: Fibronectin Glomerulopathy - PubMed AJKD Atlas of Renal Pathology: Fibronectin Glomerulopathy

🔸Mostly adults
🔸Proteinuria/hematuria
🔸ESRD 10-20 yrs
🔸No specific treatment
References:
pubmed.ncbi.nlm.nih.gov/29055354/

(2/2)

H&E showing glomerulus with MPGN-like pattern

Immunofluorescence strongly staining for fibronectin

Electron microscopy - homogeneous granular electron dense deposits

Fibronectin glomerulopathy
🔸Massive fibronectin deposits
🔸AD mutation FN1
🔸MPGN-like pattern
🔸Silver-neg, PAS+, trichrome-red
🔸EM: Homogeneous granular + variable fibrils
🔸IF/IHC strongly + fibronectin
🔸renal-limited

(1/2) more below
#renalpath #pathsky #nephsky

#RenalPath: Lecithin–cholesterol acyltransferase deficiency with mild mesangial expansion with slight foamy appearance. Capillary walls show segmental thickening (hematoxylin and eosin stain).

bit.ly/2tQDkJx (FREE)

Excuse the “taking a picture of a computer screen” quality here - this looks like early MN pattern (IgG, IgG1 here) by IF, but EM has absolutely no deposits (EM on frozen material done on this glom). Still MN (“by IF only”?!)? @glombandit.bsky.social @arkanalabs.bsky.social @jzrenalpath.bsky.social

AVF dysfunction due to partial thrombosis at the anastomosis. Previous gradual anastomotic thrombosis led to peripheral blood flow and arteriopoesis with aneurysmatous dilation of cannulation site, which is now collapsing at blood flow rates higher then 200ml/min.

Pt has DM, heavy proteinuria & CKD. Bx shows fx of nodular diabetic GS. BUT EM also shows large substructures. IF with strong fibrinogen in similar glomerular distribution as substructures. Other than linear weak IgG & albumin, Ig's & LC's (-). What could they be?
#renalpath #pathsky #nephsky

Diabetic fibrillosis?

#RenalPath: Postinfectious glomerulonephritis with irregular, coarse granular capillary loop and mesangial staining for immunoglobulin G (immunofluorescence microscopy).

bit.ly/2KwRGU4 (FREE)

Abundant amyloid. Nephrotic syndrome and AKI in a patient with history of IV drug abuse, multiple infections, and HCV. Type AA (Amyloid A IHC picture). #renalpath #pathsky #nephsky

Angry ANCA vasculitis. Pacui immune crescentic GN with exploding glomerulus. Multiple foci of necrotizing arteritis. Fibrinogen staining in necrosis in a crescent and arterial wall. #renalpath #pathsky #nephsky

My patients live at the margins of society. They don’t have much. Just getting to dialysis three times a week is a big ask. Taking from them to fund tax breaks for the rich is just cruel.

I want to be outraged but I just feel like crying.

Strong linear IgG involving proximal tubular basement membranes

Acute tubular injury

Chronic tubulointerstitial nephritis (trichrome stain)

Electron microscopy shows atrophic tubular basement membranes. No deposits are seen.

Anti-tubular basement membrane (TBM) disease
🔸Rare type of tubulointerstitial nephritis
🔸Strong linear polyclonal IgG restricted to TBMs
🔸No deposits by EM
🔸Autoantibody to TIN-ag in proximal TBM
🔸AKI/CKD, polyuria, polydipsia

Reference: ajkd.org/article/s027...

#renalpath #pathsky #nephsky

In late March, the FDA approved iptacopan to reduce proteinuria in patients with C3 glomerulopathy. With additional approvals anticipated to treat this rare condition, education on identifying and treating C3G is critical. kidney.pub/KN1706-02

#ASNKidneyNews

Example of necrotizing lupus vasculopathy. Hilar arterioles with luminal immune complex deposit and mural necrosis. Ig deposition in lumen of vessel and fibrinogen staining by IF. #renalpath #pathsky #nephsky

Immunofluorescence Use and Techniques in Glomerular Diseases: A Review Abstract. Background: Immunofluorescence (IF) studies play an essential role in the evaluation of medical renal biopsies. Particularly, in the study of renal glomerular diseases, where it provides fun...

So very happy with this publication! I hope it will assist trainees in #nephrology and #renalpath in the uses of IF.

karger.com/gdz/article/...

#RenalPath: CNI nephrotoxicity with TMA involving an arteriole (Jones silver stain).

bit.ly/2qeBWhV (FREE)

#RenalPath: Nail-patella–like renal disease (also known as LMX1B-associated nephropathy) with segmental glomerulosclerosis in a 39-year-old man with dystrophic nails, but no patellar or other skeletal abnormalities (Jones silver stain).

https://bit.ly/42h16yf (FREE)

Muddy brown granular cast and fragmented renal tubular epithelial cell cast under interference contrast illumination. Case of ATN, AKI. #UrinarySediment #UrineMicroscopy #PisseProphet #renalpath

Pediatric anti-phospholipid syndrome (APS) is a rare autoimmune inflammatory disorder resulting in recurrent vascular thrombosis w/serious clinical implications. Read these Clinical Insights into pediatric APS nephropathy.
link.springer.com/article/10.1...

Genetic testing is crucial in nephrology, as up to 10% of kidney disease patients receive a genetic diagnosis. This review aims to explain the genetic counseling process and relevance to patients, enabling comprehensive care for their genetic and clinical needs. kidney.pub/KID0825
#ASNKidney360

A membranous pattern is occasionally present in Fibrillary GN
Notice randomly arranged fibrils in the subepithelial regions. DNAJB9-positivity is seen in a similar distribution by IHC. Can be mistaken for membranous nephropathy: doi.org/10.1016/j.ekir….
#renalpath #pathsky #nephsky

Case of IgAN in the setting cirrhosis with prominent red blood cell casts with fairly focal crescents. Pt was biopsied for gross hematuria. #renalpath #pathsky #nephsky

Nice example of cryoGN in a Sjogren pt. Somewhat early kidney presentation with some active crescents without well-developed MPGN features. IgM-k dominant, less IgG/L (type II cryo). Cryo plugs in vessels. Great micro-tubles by EM. #renalpath #nephksy #pathsky

Oh look, a list of the 30 best nephrology podcasts.

www.millionpodcasts.com/nephrology-p...

Older female pt with slowly progressive CKD, long h/o HTN. 0.5 g proteinuria. Biopsy with revealed a surprise with many podocytes demonstrating myelin figures. Main ddx includes Fabry versus drug effect (excluded in this case). pubmed.ncbi.nlm.nih.gov/35100945/. #renalpath #pathsky #nephsky