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Striking example of light chain cast nephropathy with intra-tubular amyloid phenotype in an MM pt. PAS pale atypical casts with cellular reaction. Fuzzy periphery with spicules and + congo red. #renalpath #nephsky #pathsky

submitted 2 days ago • 0 comments

Rare case of AA amyloidosis occurring in a patient with membranous LN. LN+amyloid is a surprising rare occurrence. pubmed.ncbi.nlm.nih.gov/20477021/ #renalpath #nephsky #pathsky

submitted 3 days ago • 1 comment

Our review on Post-Transplant TMA is out in JASN! In this series, we outline pathophysiologic mechanisms of TMA & diagnostic workflow. 🙏 @rajmehrotra.bsky.social & #DavidEllison for invitation & fabulous co-authors @nephrosparks.bsky.social & #DavidKavanagh journals.lww.com/jasn/abstrac...

submitted 5 days ago • 0 comments

Doesn't get much worse than this. Severe vascular rejection (transmural inflammation and necrosis - v3) in a transplant bx. Also severe tubulointerstitial inflammation/C4d+, mixed AMR/ACR. #renalpath#nephsky #pathsky

submitted 5 days ago • 0 comments

The image shown comes from a kidney transplant patient with a rise in serum creatinine. What is the most likely diagnosis and what immunohistochemical stain would you want to rule out a less common disease sometimes seen in kidney transplants? #DiagnoseThis #renalpath #nephropath

submitted 6 days ago • 1 comment

Representative of the type of sampling in too many kidney biopsies these days. We should be hounding the IR community for process improvement (this biopsy from an outside client). #Renalpath #nephsky #radiology #pathsky

submitted 18 days ago • 3 comments

Occasional thin appearing GBM segments can be seen cases of advanced diabetic glomerulopathy (1-5% of surface areas) with otherwise thickened GBM. Thought to represent new vessel formation; not to be confused for COLIV related disease. #renalpath #nephsky #pathsky pubmed.ncbi.nlm.nih.gov/2456298/

submitted 19 days ago • 0 comments

Staph epidermidis + urine culture not always contaminant. KTx Bx with rising sCr. Patchy neutrophilic casts and interstitial inflammation suggestion of acute pyelonephritis. #renalpath #nephsky #pathsky

submitted 22 days ago • 0 comments

Diabetic kidney disease involves all kidney compartments. Examples of severe arteriolar hyalinosis of both afferent and efferent arterioles (characteristic of DN) and very thickened tubular basement membranes. #renalpath #pathsky #nephsky

submitted 23 days ago • 0 comments

Pronase IF can be very helpful in cases of cryo-GN as the frozen IF is often masked. This case also showed classic hyaline pseudo-thrombi, cryo-vasculitis, and microtubules by EM. #renalpath #pathsky #nephsky

submitted 25 days ago • 0 comments

Why do the PDF versions of submitted papers compress the figure images so much? It's annoying for the reviewer and often results in request for the authors to provide higher res images when in fact the original versions are fine? #nepsky #renalpath #pathsky

submitted 29 days ago • 2 comments

@askrenal.bsky.social 41F first occurrence of minimal change. Biopsy shows IgG dusting, raising suspicion for antinephrin. Responding to steroids (complete remission in 5~wk), but is there an instance where we might treat these patients with rituximab to start?

submitted 33 days ago • 2 comments

Can we please stop using the term "apple green" for amyloid polarization with congo red. It's often yellow/orange and the green is typically not apple colored. I have heard folks not want to diagnose amyloid b/c it wasn't green. pubmed.ncbi.nlm.nih.gov/26177276/ #pathsky #nephrology #renalpath

submitted 34 days ago • 6 comments

#RenalPath Bile nephrosis with intratubular yellow-green granular casts. Acute tubular injury and intratubular cellular debris are present (hematoxylin and eosin stain). https://bit.ly/4fULzHE (FREE)

submitted 35 days ago • 0 comments

What is your diagnosis? #DiagnoseThis #renalpath #nephropath

submitted 34 days ago • 2 comments

Younger pt who presented with history of diarrhea and AKI without significant PMHx and no medication use. Bx demonstrated Granulomatous interstitial nephritis. Colon biopsies with chronic active colitis with granulomas c/w with crohn disease --> GIN (no mesalamine) #renalpath #pathsky #nephsky

submitted 35 days ago • 2 comments

Lambda-restricted myeloma cast nephropathy Diffuse ATN Glassy fractured eosinophilic casts on H&E w cellular reaction PAS pale Polychromatic (red and blue) on trichrome #pathsky #nephsky #medsky

submitted 35 days ago • 0 comments

Elderly patient with DM ,HTN, CAD p/w SOB, edema, AKI, & oliguria. Low C3. UA 3+ prot,wbcs+rbcs. Urine Cx +ecoli. Acute bacterial infection-related GN-exudative (lots of neutrophils) and starry sky C3 (IF) + hump-like subepithelial deposits (EM) t.co/q3QEy4ZnQP #renalpath #PathSky #NephSky #MedSky

submitted 35 days ago • 1 comment

While C3 by pronase IF on FFPE is less sensitive/reliable, it can still be helpful when positive. Left frozen C3, right FFPE C3 from a case of recurrent C3GN in a txp. Did IF par to rule out masked deposits just in case (there were non). So the stain can work. #renalpath #pathsky #nephsky

submitted 36 days ago • 0 comments

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

submitted 37 days ago • 0 comments

🔬 Interested in Healthcare, Research, or Lab work? We are hosting a CLS Informational Session on Monday 2/3! Food will be provided to the first 100 to RSVP as in-person attendees! Come network and learn more about Clinical Laboratories! RSVP by Fri 1/24 ➨ bit.ly/3WtwjKO

submitted 38 days ago • 0 comments

Reminder to carefully review non-neoplastic tissue in tumor nephrectomies. #renalpath always takes a quick look here. Slightly tedious but can be very useful. RCC patient with extensive amyloid deposition. Amyloid A IHC positive (can be seen with RCC) but mass spec pending. #pathsky #nephsky

submitted 40 days ago • 0 comments

Genetic Testing 🧬 in CKD ca. 2024 #Nephpearls #NephSky 👉 pubmed.ncbi.nlm.nih.gov/39288914/

submitted 41 days ago • 0 comments

What is your diagnosis? #DiagnoseThis #renalpath #nephropath

submitted 41 days ago • 1 comment

1/n One of the things that I find valuable in internal medicine in general is pattern recognition. And nephrology is not the exception. AKIs come in different flavors, we can smell the etiology based on the presentation and the way the serum Cr (sCr) rises.

submitted 42 days ago • 1 comment

Lupus membranous is often the most membranous membranous (most membranous-sy?) #renalpath #nephsky #pathsky

submitted 43 days ago • 2 comments

There is a C3 nephritic factor in ~50% of C3G. There are anti-c3 antibodies in ~25% of lupus nephritis. but lupus almost never has C3 nephritic factor What gives? #askrenal @askrenal.bsky.social @anujajava.bsky.social

submitted 44 days ago • 1 comment

A nice example of #CutaneousAmyloidosis which read the 📖. Amorphous deposits of eosinophilic, congo 🔴 + material in dermis & vessels, showing 🍏 green birefringence under polarised 💡. #pathology #dermatology #PathSky 😉

submitted 44 days ago • 1 comment

KBx: +HIV (ART, -PCR), +HCV (-PCR for years), EtOH cirrhosis, recent cellulitis bx for NR proteinuria. MPGN, IgM dominant but full house IF with prominent IgA. Vague organized deposits and glom lipidosis. Cause? HCV/cryo, cirrhosis, HIV, and/or cellulitis? #renalpath #nephsky

submitted 44 days ago • 0 comments

Glomerulonephritis with #Bartonella endocarditis www.kireports.org/article/S246... in @kireports.bsky.social We have had a few cases locally as well. Is this an upsurge of cases or better diagnoses? #NephSky #IDSky

submitted 45 days ago • 1 comment

Interesting how some amyloid cases show respect for the GBM, do not cross and do not cause significant podocyte injury or proteinuria. Probable LECT2 case, though pt has MGUS, so mass spec pending. #nephsky #pathsky #renalpath

submitted 45 days ago • 1 comment

A glomerulus touched by lupus. Example of finger print type deposits in this patient with lupus nephritis. #renalpath #pathksy #nephsky

submitted 45 days ago • 0 comments

Tiny thromboembolism (cholesterol clefts and giants cells) in a single glomerular capillary loop. Kidney transplant pt; had coronary artery stenting a few years ago. Probably incidental finding. #renalpath #pathtsky #nephsky

submitted 46 days ago • 0 comments