sudhir babu

Dermpath/Renal Pathologist, Apollo Hospitals

[sudhir babu @sudhirpath]

@grace_choung Important update to this! Trichrome staining in fibronectin glomerulopathy turns out to be highly variable. See the tweet by @SethiRenalPath

[Sanjeev Sethi @SethiRenalPath]

Trichrome and silver stain.
Silver negative deposits.
Trichrome is negative as well.

[sudhir babu @sudhirpath]

@grace_choung One peculiar feature of fibronectin glomerulopathy: it’s the only glomerular deposition disorder with red deposits on trichrome stain — a distinctive clue. #renalpath #PathTwitter

[Sanjeev Sethi @SethiRenalPath]

This was a difficult but good teaching case.

Easy to call idiopathic MPGN but…

LM: Membranoproliferative Glomerulonephritis (MPGN) pattern

IF- dull minimal IgG IgM C3 kappa lambda

EM- massive deposits.

Pronase IF/IgG subclass all negative. At this point I had an idea-
FIBRONECTIN GLOMERULOPATHY

Did mass spectrometry. Confirmed the diagnosis=Large amounts of fibronectin.

55 yr old with proteinuria and declining renal function.

[sudhir babu @sudhirpath]

@SethiRenalPath Excellent teaching case Sir. Could you please share the Masson trichrome stain for this case ? I have always felt that fibronectin glomerulopathy is perhaps the only glomerular deposition disease showing characteristic red deposits on Masson trichrome. Would you agree?

[sudhir babu @sudhirpath]

@ariabdullah1978 We can do Vimentin and if it’s positive, will release as Undifferentiated pleomorphic sarcoma

[Jonathan Zuckerman MD PhD @JZRenalPath]

Multiple diagnoses not uncommon in kidney biopsies. This case showed nodular diabetic nephropathy, a mostly chronic ANCA associated GN, and to top it off some interstitial ALECT2 amyloidosis. #renalpath #nephrology #PathTwitter

[Renal Pathology Society @Renalpathsoc]

The Renal Pathology Society warmly invites nephropathologists and non-pathologists involved in the interpretation of kidney biopsies to participate in a global survey.
More info. below 👇
https://t.co/BIIDgPid6u
@GlomCon @ISNkidneycare #renalpath

[sudhir babu @sudhirpath]

@JerasitS @grace_choung Thank you for sharing this striking image, Jerasit. Perhaps fibronectin glomerulopathy should be considered in the differential whenever red deposits are seen on Trichrome in glomerular deposition disorders. #renalpath @JZRenalPath @vinaypush @RitambhraN

[sudhir babu @sudhirpath]

@kiddo_kidney @Renalpathsoc @draalok @RitambhraN @vinaypush @JZRenalPath Protein reabsorption droplets are mainly (pink) granular rather than vacuolar. These droplets are highlighted by PAS stain and are commonly identified in Nephrotic syndrome.
Will try to share some pics soon.

[sudhir babu @sudhirpath]

Isometric vacuolization of tubular epithelial cells (foamy tubular cells) in a case of Acute CNI toxicity #renalpathology #CNItoxicity #isometricvacuolization @draalok @RitambhraN @vinaypush @JZRenalPath @Renalpathsoc

[sudhir babu @sudhirpath]

https://t.co/QBOeqM3ChC
#Dermpath #Pathology #Histopathology #medicaleducation

[sudhir babu @sudhirpath]

@JMGardnerMD EMPD

[Jonathan Zuckerman MD PhD @JZRenalPath]

Capillary wall "eye-lashes" not always amyloid. Rare finding in a recent fibrillary case. IF = IgG. IHC = DNJAB9. Congo red (-). #renalpath #pathtwitter

[Jonathan Zuckerman MD PhD @JZRenalPath]

Older patient with anasarca. Bx with massive glomerular amyloidosis - AH type. IF and EM reveal concurrent heavy chain deposition disease. Unusual dual diagnosis. #renalpath #nephrology #pathtwitter

[sudhir babu @sudhirpath]

Glomerular foam cells occluding the capillary loops (Bloodless glomeruli) in a case of Acute CNI toxicity #renalpathology #CNItoxicity #isometricvacuolization
@draalok @RitambhraN @vinaypush @JZRenalPath
@Renalpathsoc

[Jonathan Zuckerman MD PhD @JZRenalPath]

Nice example of striped fibrosis which is often attributed to chronic CNI toxicity in kidney transplant biopsies. #renalpath #pathtwitter

[Jonathan Zuckerman MD PhD @JZRenalPath]

AKi in a pt with recent contrast administration and antibiotic use. Features of contrast nephropathy and allergic interstitial nephritis. #renalpath #pathtwitter

[sudhir babu @sudhirpath]

@draalok @RitambhraN @vinaypush @JZRenalPath @Renalpathsoc Before making a diagnosis of acute CNI toxicity with Tubular foam cells, we need to think of:
1. Ischemic acute tubular injury
2. Osmotic tubulopathy
3. Potassium depletion
4. Nephrotic syndrome

[Jonathan Zuckerman MD PhD @JZRenalPath]

A reminder that cryoglobulinemic glomerulonephritis can still occur post-HCV treatment. Biopsy for hematuria, proteinuria, and elevated sCr. Low c3/c4. +cryocrit and RF. #renalpath #pathtwitter