Value of pronase IF in renal path. MN pattern with dominant C3 staining becomes membranous like glomerulopathy with IgG kappa deposits on pronase IF. SAP + confirms diagnosis. #renalpath #nephsky #pathsky

Another interesting case with crescents but this time due to amyloid. A few small cellular crescents in this case of AL-amyloidosis. Massive capillary wall amyloid infiltration. #renalpath #pathsky #nephsky

Fibrin extravasating into Bowman's capsule in this case of MPO-ANCA associated pauci immune GN. Destructive necrotizing cellular crescent. Prominent necrotizing arteritis as well. #renalpath #pathsky #nephsky

This one read the textbook. An unfortunately florid case of TMA with acute and chronic features. Glomerular thrombosis, arterial mucoid intimal edema, and onion skin changes. Fibrinogen highlights thrombi on IF. #renalpath #nephky #pathsky.

When it's not just diabetes. Pt with DM, CKD, and worsening proteinuria. Biopsy with diabetic glomerulopathy with superimposed IgG3-k restricted MPGN c/w PGNMID. #renalpath #pathsky #nephsky

Not often caught on sections but example of penetrating vessels within the renal capsuled demonstrating the small amount of collateral circulation to the subcapsular cortex. #renalpath #pathsky #nephsky

Haven't seen one of these in a while. Example of atheroembolism in a older pt with subacute kidney injury and peripheral vascular disease. Cholesterol clefts and giant cells filling the arterial lumen. #renalpath #pathsky #nephsky

Interesting case of polytypic ITGN with masked deposits in a patient found to have sarcoidosis. No lymphoproliferative disorder. See report here: www.sciencedirect.com/science/arti... #renalpath #pathsky #nephsky

PR3-ANCA associated GN with vasculitis. Temporal heterogeneity can be seen in the vasculitis lesion with both active fibrinoid necrosis and transmural sclerosis with mural disruption c/w old scared vasculitic lesions. Acitve crescents too. #renalpath #pathsky #nephsky.

Feature of chronic active glomerular microangiopathy in a pt with a bone marrow transplant. Mesangiolysis and capillary wall double contours. Few schistocytes as well. Subendothelial floculent material seen by EM. #renalpath #pathsky #nephsky

The yellow highlights the macrophage cell membrane and the engulfed deposits in lysosomes.

Pt with SLE and sjogren with hematuria and proteinuria. +++RF, low C3/C4, IgM-k MGUS. Biopsy revealed IgM-k dominant GN with cryo plugs + vasculitis + abundant pure microtubular deposits c/w cryoGN. Some deposits being engulfed by macrophages. #renalpath #pathsky #nephsky

Sometime the casts have eyelashes. Amyloidogenic variant of light chain cast nephropathy. #renalpath #nephsky #pathsky

Interesting finding of large multi-nucleated endothelial cells in a txp biopsy with chronic active AMR. IHC stain is ERG (endothelial cell marker). Probably just a manifestation of chronic endothelial cell injury in this setting #renalpath #pathsky #nephsky

Exuberant capillary wall spicules in this case of amyloidosis, AHL type. Amyloid spike by EM ('Bart Simpson sign'). #renalpath #pathsky #nephsky

Case of HTRA1 Membranous Nephropathy With Polytypic IgG Concurrent With New Plasma Cell Dyscrasia. Coincidence or related? www.sciencedirect.com/science/arti... #renalpath #pathsky #nephsky

Interesting case of Contactin-1 Associated Membranous Nephropathy after multiple mRNA 1273 COVID-19 Vaccinations without neuropathy. #renalpath #nephsky #pathsky karger.com/gdz/article/...

One of my favorite incidental EM findings. Crystalline proto-renin granules in JGA cells. #renalpath #nephsky #pathsky

It's not always diabetic nephropathy. Pt with DN, HTN, and nephrotic range proteinuria. Elevated K/L ratio. Bx with Light and Heavy Chain deposition disease mimicking nodular diabetic glomerulopathy. #renalpath #pathsky #nephsky

Striking viral inclusion in this case of polyomavirus nephropathy. SV40 stain is confirmatory. #renalpath #pathsky #nephsky

Cut some unstained slides from IF tissue which demonstrated nice polarizable crystals. #renalpath #pathsky #nephsky

Fibrillary or amyloid? How about both! Concurrence of ALECT amyloidosis and DNAJB9+ FGN. EM shows admixed but distinct fibril population. Mass spec was required for definitive diagnosis. www.sciencedirect.com/science/arti... #renalpath #nephsky #pathsky

Txp biopsy with rare probable cystine crystals in interstitial mononuclear cells in a patient with history of cystinosis. Rarely seen post-txp not clinically significant to my knowledge. #renalpath #pathsky #nephsky

MPO+ANCA GN with concurrent low grade membranous nephropathy. MPO positivity in the MN deposits helps support a unifying etiology is such cases. pubmed.ncbi.nlm.nih.gov/40485711/ #renalpath #nephsky #pathsky

Autopsy case with incidental ALECT2 amyloidosis with lung involvement. Essentially invisible by light microscopy. Wonder how often this is overlooked. 94% of cases had alveolar involvement in this study (PMID: 26912093). #pathksy #renalpath

Transplant bx for renal dysfunction in a patient with shortness of breath. Granulomatous tubulointerstitial nephritis. AFB stain +. Sputum + for TB. Good sample key for making the diagnosis. 2 rounds of AFB stain to find the organism. #renalpath #pathksy #nephsky

Bx for pt with AKI and nephrotic range proteinuria. Hx of IV drug abuse (with skin popping), and chronic staph infections. AA amyloidosis was the unsurprising finding. #renalpath #pathsky #nephsky

Bx for AKI in a pt on checkpoint inhibitor: neutrophil rich tubulointerstitial nephritis. We would usually think pyelonephritis, high risk neutrophil rich variants of CKI inhibitor AIN have been characterized. pubmed.ncbi.nlm.nih.gov/41727781/ #renalpath #pathsky #nephsky

Classic powdery electron dense deposits along GBMs, TBMS, and in vascular walls by EM in this case of light chain deposition disease. #renalpath #pathsky #nephsky

Don't confuse these for crystals. Limiting membrane of peroxisomes in proximal tubules. Normal tubular structure. Mimic of light chain proximal tubulopathy. #renalpath #pathsky #nephsky