Renal Pathologist, Mayo Clinic, Rochester, MN. I love kidneys. Tweets are my own, not medical advice.
Rochester Minnesota
Joined November 2017
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Sometimes you are able to share everything you love and treasure in one single shot. My ❤️ space @MayoClinicPath @MayoClinic
Priya Alexander, MD retweeted
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To confirm the interstitial amyloid was ALECT2 amyloid.
The patient was Hispanic. ALECT2 was likely an incidental finding.
Check out this very timely publication ⬇️
Co-occurrence of systemic anti-neutrophil cytoplasmic antibody-associa… sciencedirect.com/science/ar…
I have often paused thinking a case has fine dusting only to note that there is a generalized tissue ANA effect ( as seen here).
Just wanted to raise awareness to what is a probably well recognized diagnostic pitfall.
Immunofluorescence image of a glomerulus seen on this IgG stained section.
Patient has lupus with proteinuria.
Thoughts?
Every biopsy teaches me something.
1. Don’t be restricted by the clinical presentation. Expect the unexpected.
2. A limited biopsy can still be worth a million 💰
Bx shows: FSGS ( no ANCA crescents)
Now see arrows.
Now see Congo red.
Interstitial amyloid (not AL).
A patient who 7 years prior had renal bx proven ANCA vasculitis (MPO) ( was treated with Rituximab, now presents with ⬆️ proteinuria and ⬆️ creat. MPO ANCA elevated. Limited sample. Thoughts?
Priya Alexander, MD retweeted
When is thrombosis merely coincidental with an M-protein, and in which thrombotic disorders is there evidence that the M-protein itself can be pathogenic?
In our new review doi.org/10.1002/ajh.70467, we propose a framework for Monoclonal Gammopathy of Thrombotic Significance.
Priya Alexander, MD retweeted
We already recognize:
- Kidney → MGRS
- Nervous system → MGNS
- Skin → MG cutaneous significance
So what about thrombosis → MGTS?
The challenge: thrombosis is common, multifactorial, and rarely diagnostically specific.
Excellent time last week at ADLM with our outstanding colleagues from Mayo Clinic Supply Chain Management. So much to learn from the wonderful Mayo DLMP team that functions forcefully and silently in the background. Teamwork and excellence at play every day.
The gift which I am sending you is called a dog, and is, in fact, the most precious and valuable possession of mankind." – Theodorus Gaza, a Greek humanist and translator of Aristotle
Sasha Alexander ❤️ 2013-2026.
Check out our editorial @caschinstock @MayoClinicNeph @MayoTransplant
Accelerating Mechanistic Biomarker Discovery in Antibody-mediated Rejection Through Spatial Transcriptomics ovid.com/10.1097/TP.00000000…
Spatial Analysis Identifies Endothelial HLA-F as a Prognostic Marker in Antibody-mediated Rejection ovid.com/10.1097/TP.00000000…
In my years of staring at EMs I have never encountered an “Asteroid” body.
In case you have not either:
Necrosis granulomatous interstitial nephritis: often infections, such as TB.
Sarcoidosis = commonly non-necrotizing granulomatous.
This renal bx shows large nodular foci of necrosis and granulomata + large MN giant cells.
Case of sarcoidosis.
@Renalpathsoc
#Asteroid body
Necrosis granulomatous interstitial nephritis: often infections, such as TB.
Sarcoidosis = commonly non-necrotizing granulomatous.
This renal bx shows large nodular foci of necrosis and granulomata + large MN giant cells.
Case of sarcoidosis.
@Renalpathsoc
#Asteroid body
So, in summary Occam’s razor would have failed us here.
This is in fact supportive of the philosophy of Saint and Hickam.
Great reading here 👇🏼
Occam's Razor versus Saint's Triad | New England Journal of Medicine nejm.org/doi/full/10.1056/NE…
1/3: A middle-aged lady with diabetes presented with worsening creatinine & increasing proteinuria. She had hypocomplementemia & ++ANA. Bx: Nodular glomerulosclerosis , interstitial inflammation, & IF: immune deposits: glomerular & interstitial
Dx: Diabetic GS & auto immune GN
As expected EM shows nodular mesangium and immune complexes and TRI.
Ockham’s razor
However not as simple as that:
Amyloid fibrils also present. So, let’s revisit the light microscopy.
Priya Alexander, MD retweeted
Presented at #ERA26:
In adults without diabetes who had chronic kidney disease, the nonsteroidal mineralocorticoid receptor antagonist finerenone led to a slower decrease in the estimate glomerular filtration rate than placebo over 32 months. Full phase 3 FIND-CKD trial results: nej.md/4wWOFV4
@ERAkidney
ALT Graph comparing mean eGFR slopes between finerenone and placebo groups. The chart has three sections: Total, Baseline to Month 3, and Month 3 to End of Treatment. Numerical values are provided above the bars, showing treatment differences with confidence intervals.