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

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

C3 Glomerulopathy with Occult Gammopathy Treated with Low-Dose, Fixed Duration Venetoclax - Kidney International Reports www.kireports.org/article/S246...

#mRNA Sequencing to Identify #Aberrant Splicing in X-linked #Alport Syndrome #VisualAbstract by Susan Thanabalasingam https://www.kireports.org/article/S2468-0249(26)02785-3/fulltext

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

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

A pediatric case of C3 glomerulonephritis initially misclassified as IgA nephropathy with a favorable response to C3-targeted therapy #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

Yes- horses can get membranous nephropathy! Really nice spikes and holes on the silver stain and subepithelial complexes confirmed on EM. This horse had nephrotic edema and hypoalbuminemia. UPC was 5.8. #vetneph

The Armanni-Ebstein (not Epstein😅) lesion in a nondiabetic patient The glycosuria from flozination can cause these, very interesting phenomenon www.kidney-international.org/article/S008... in Kidney International #RenalPath

Crystalglobulin-Induced Nephropathy and Cardiac Non-amyloidotic Immunoglobulin Deposition Disease: A Fatal Case Report #nephsky #nephrology www.kidneymedicinejournal.org/article/S259...

Autolysis versus ATN in an autopsy specimen. Autolytic tubules show detachment of epithelial cells from tubular BM and seem to fall off into the lumen (yellow circle). Rest of tubules with ATN: epithelial cells on the BM but thin + loss of brush borders. #renalpath #pathsky

Allograft biopsy for AKI after belatacept conversion. Yikes! Acute cellular rejection grade III with necrotizing arteritis. #renalpath #pathsky #nephsky

Some large KW nodules in this case of diabetic nephropathy. Unfortunately a common occurrence in my biopsy practice. #renalpath #pathsky #nephsky

Another chronic glomerulopathy case. EM stage IV of IV resorbed deposits in a pt with PLA2R+ Membranous nephropathy with persistent proteinuria. #renalpath #pathsky #nephsky

Recent bxs are so important for clinical trial enrolment. Bx in pt with hx of lupus nephritis (IV+V) with worsening proteinuria. Bx for trial enrollment. Chronic changes only, 0 activity, resorbed deposits by EM, min IF staining. #nephsky #renalpath #Pathsky

Bx in older F pt for subnephrotic proteinuria reveals numerous myelin figures in podocytes. Concern for Fabry + other genetic diseases. Subsequently learned the pt was on long term to Plaquenil. Genetics pending, but may all be HCQ tox. #renalpath #pathsky #nephsky

Kidney biopsy day, real-time renal US-guided; adequacy verification, cortex obtained, glomeruli visualized. Come join us to learn more about this in the #KidneyBiopsyAcademy hands-in workshop at @kidneycon.bsky.social 2026

Somewhat subtle case of light chain cast nephropathy by LM. Mostly fine granular casts. Rare PAS pale + two toned color casts. No cellular reaction. IF with K restricted casts confirmatory. EM demonstrates LC precipitation with uromodulin. #renalpath #nephsky #pathsky

Interesting case of necrotizing vasculitis in a lupus patient. Hx of LN in prior biopsies, no active GN features now. May be lupus vasculitis, but recommend r/o superimposed vasculitic disease (e.g., ANCA, drugs) with such biopsies findings. #renalpath #nephsky #pathsky

Tumor nephrectomy with incidental ALECT2. Interestingly this was from a pt from India. Reminder that a subset of ALECT2 cases have been reported in Punjabi patients (pubmed.ncbi.nlm.nih.gov/35986199/) . #renalpath #pathsky #nephsky

Bone Marrow Examination in Proliferative Glomerulonephritis with Monoclonal Ig Deposition: A Serology-Based Approach - Kidney International Reports www.kireports.org/article/S246... #pathsky #nephsky #nephrology

Leucocyte tickling a tubular epithelial cells in a case of cellular rejection in a txp biopsy. Can anyone with more immunology knowledge than me explain what is happening here? #renalpath #nephsky #pathsky

Classic global granular capillary wall staining with IgG in this case of membranous nephropathy. #renalpath #pathsky #nephsky

Young F pt with nephrotic range proteinuria. Membranous pattern injury with near negative frozen IF. Pronase IF unmasks IgG-K staining. SAP is positive. Membranous-like glomerulopathy with masked IgG-kappa deposits. pubmed.ncbi.nlm.nih.gov/32001064/ #renalpath #nephsky #pathsky

Case of IgAN with massive hemispherical mesangial deposits. Mimics cryo-plugs but deposits are mesangial rather than filling capillary loops. #renalpath #pathsky #nephsky

Pauci-Immune Endocapillary Proliferative GN with Glomerular M2 Macrophage Infiltration - Kidney International Reports www.kireports.org/article/S246...

Dual AL/AH amyloidosis in a pt with plasma cell dyscrasia. Mass spec was confirmatory. #renalpath #pathsky #nephsky

Another example of how IgAN is not a benign disease. Middle age pt with CKD, hematuria, proteinuria. Strong mesangial IgA staining and deposits by EM. Unfortunately extensive IFTA at diagnosis. Can we catch these pts earlier? #renalpath #athsky #nephsky

Well formed non-necrotizing granulomas in a pt with worsening renal function and sarcoidosis. Some granulomas in peri-vascular locations without vasculitis. #renalpath #pathsky #nephsky

Some smudgy mesangial IgG staining indicating a surprise fibrillary GN superimposed on advanced diabetic nephropathy. EM was confirmatory (~14 nm fibrils in some mesangial areas) as was the DNAJB9 stain. Value of biopsy in diabetic pts. #renalpath #nephsky #pathsky

Bx for progressive CKD in a pt with CML, in remission. Limited biopsy with prominent debris filled proximal tubule lysosomes + for lysozyme (no evidence for light chain restriction (F/P) or chromogranin). Suspicious for lysozyme nephropathy. #renalpath #pathksy #nephsky

One of the more subtle cases of amyloidosis I have seen. Few spicules on silver stain. Minimal congo red positivity. Despite early amyloid deposition, pt had nephrotic syndrome. Likely AL type (pt has LPL); MS pending. #renalpath #pathsky #nephsky

So many eosinophils in this case of tubulointerstitial nephritis secondary to recent antibiotic administration. Few tiny granulomas as well. Eos seen in EM as well. #renalpath #pathsky #nephsky