Unexpected in pt with HIV: High suspicion required to pick up IgG4-RD

LM: extensive interstitial inflammation & fibrosis.
Numerous cells +++ for both IgG & IgG4.

Background fibrosis was a giveaway.

Dx: IgG4-related renal disease

45-yr with HIV, under control, rise in Cr to 4.

On my way home from WCN. Attended some great talks, met up with friends & colleagues, & visited the lovely city of Buenos Aires. I particularly liked sharing the ApoE and Dense Deposit Disease (DDD) story in the session on glomerulonephritis. Thank you #ISNWCN for inviting me.

I had no idea at first, then it suddenly hit me.

1. Normal glomeruli,no FSGS
2. Tubules filled with large granules
3. IF negative=not light chain tubulopathy

Chromogranin +++ in tubules

Dx: Neuroendocrine tumor-associated tubulopathy

65-yr, diabetes, HTN, pancreas mass, ⬆️ Cr

In 166 patients with AAV-GN and eGFR <15mL/min/1.73m2, lower chronicity grades on kidney biopsy were predictors of dialysis discontinuation and kidney failure recovery regardless the use of PLEX particularly in PR3-ANCA, GPA, and SCr < 5.7 mg/dL fernando fervenza Sanjeev Sethi

Proteinuria in lupus today. Think outside of lupus nephritis & membranous lupus nephritis.

Bx:
LM: normal appearing glomeruli
IF: negative
EM: diffuse foot process effacement

Dx: Minimal change disease/lupus podocytopathy.

35-yr man with lupus, UA 4+ protein 2+ blood, + dsDNA

Completely unexpected.

4 cores of kidney biopsy tissue.

3 cores showed diabetic nodular glomerulosclerosis.

But one entire core showed a renal clear cell papillary tumor.

55 yr-old with diabetes, hypertension and rise in creatinine.

📃 Membranous nephropathy—diagnosis and identification of target antigens #OpenAccess #Review #DiagnosticStandard
🔗 bit.ly/3vwVFNy @ndtsocial Hans-Joachim Anders
👤 Sanjeev Sethi fernando fervenza

Nice teaching case.

1. Focal proliferative lupus nephritis (ISN/RPS class III) +

2. Membranous lupus nephritis, class V,
based on positive Exostosin staining.

Got the EXT2 stain before electron 🔬 confirming membranous lupus nephritis.

23 yr old, lupus, proteinuria, ⬇️ C3 C4

Lipid in glomerular basement membranes (GBM)-think severe liver disease

LM: Thick GBM, mesangial matrix expansion
IF:Neg
EM: lipid vacuoles in thick GBM

Dx: Hepatic glomerulopathy

D/D: lecithin-cholesterol acyltransferase deficiency

28 yr-old with congenital cirrhosis & ⬆️ Cr

Finally. We figured out the dense deposits in dense deposit disease (DDD).

The answer is Apolipoprotein E.

You can stain for APOE & make the diagnosis of DDD in >80% cases. Without electron 🔬.

DDD was the reason I got into mass spectrometry 17 yrs ago. doi.org/10.1016/j.kint…

1. Focal necrotizing lupus arteritis.
Plus severe lupus vasculopathy.

Can be missed and is unfortunately not part of the lupus classification.

2. Glomeruli showed mesangial lupus nephritis, class II.

40-yr old woman with lupus & rise in serum creatinine,+ lupus anticoagulant.

Monoclonal Immunoglobulin Crystalline Membranous Nephropathy: A Case Report

buff.ly/3wrUuiM

Sanjeev Sethi Mayo Clinic Labs

This is a great review on mechanisms, pathophysiology, aging, assessment of the kidney biopsy, importance in clinical trials, and finally the therapeutic approaches to renal fibrosis.

From inflammation to renal fibrosis: A one-way road in autoimmunity? sciencedirect.com/science/articl…

Anticoagulant-associated hematuria.

It’s simple but easy to miss.

RBC’s in tubules.

RBC’s in glomeruli-in urinary space in between tufts & in Bowmans space.

No RBC casts, RBC’s look fresh (arrows).

60 yr-old with hematuria, MGUS, DVTs & CKD. Rule out MGRS. On anticoagulants.

Here comes MARKUS at HOMe's first 2024 NDT Special

Andreas Kronbichler & I are honored to host tonight (the) 2 world leaders in #MembranousNephropathy fernando fervenza and Sanjeev Sethi

Academic partners SFNDT ÖGN - Österreichische Gesellschaft für Nephrologie Deutsche Gesellschaft für Nephrologie (DGfN) e.V. youtu.be/mfGovwLXzK0?si… via YouTube

Clinicopathologic Characteristics, Etiologies, and Outcome of Secondary Oxalate Nephropathy - Mayo Clinic Proceedings mayoclinicproceedings.org/article/S0025-…