explore | Grilled Cheese

Here's today's #eyeSCANdy!
This scan is showing intestinal giardia in a renal biopsy.

Photo courtesy of Dr. Stephen Bonsib. #renal #pathology #kidneypath

The images show lymphocytic tubulitis as well as an eosinophil-rich interstitial inflammatory infiltrate. These findings are consistent with acute interstitial nephritis...

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The crystals are characteristically black by Jones methenamine silver stain(C).

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In the native kindney, this finding is most commonly seen in cryoglobulinemic vasculitis (which was the case for this patient). The differential diagnosis would include other forms of vasculitis such as ANCA-associated diseases.
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This photomicrograph shows an artery with intimal edema and inflammation in a renal biopsy from a 56 year old male with renal failure and nephrotic-range proteinuria. The patient's serologic work-up revealed evidence of an HCV infection and a positive..
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Interestingly, the perihilar focal segmental glomerulosclerosis identified here was present in numerous glomeruli as well as marked glomerulomegaly.

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As suspected, extensive accumulation of intra-podocyte myeloid bodies (a.k.a. zebra bodies, myelinosomes) are seen in all podocyte cell bodies examined (see image below). And, subsequent testing revealed Fabry disease in this patient.

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And, while myeloid bodies can be seen in patients on chloroquine or hydroxychloroquine therapy, they are typically sparse or focal in these settings.

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This photomicrograph of a Jones silver stain is interesting in that it shows two findings. First, at 10 o’clock an area of hyalinosis at the perihilar region is present and compatible with perihilar focal segmental glomerulosclerosis.

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Here is today’s #eyeSCANdy! Acellular scanning EM from a biopsy with membranous glomerulonephritis showing depressions and larger "craters" along the subepithelial aspect of the basement membrane.
Photo courtesy of Dr. Stephen Bonsib. #renal #pathology #kidneypath

The immunofluorescence study is negative. What is your diagnosis?

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Here is today’s #eyeSCANdy! Acellular scanning EM showing "craters" at high power on the subepithelial aspect of the glomerular basement membranes from a biopsy with membranous glomerulonephritis
Photo courtesy of Dr. Stephen Bonsib. #renal #pathology #kidneypath

Here is today’s #eyeSCANdy! Acellular scanning EM of a glomerulus with membranous glomerulonephritis, stage II showing diffuse reticular appearance of GBM elaboration.
Photo courtesy of Dr. Stephen Bonsib. #renal #pathology #kidneypath

What is the most likely diagnosis?

#DiagnoseThis #nephtwitter #pathtwitter #renal #kidneypath