Case 28: Additional Pathology

Case 28 Index

Take a look at the electron microscopy (EM) below:

Electron Microscopy (EM)28 EM

Click here to zoom in on the EM!
Which of the following is the next best question to ask your pathologist?
What is the size of the fibrils?
Great! The fibrils are 10 nm.
Can I take a look at the immunofluorescence (IF)?
Unfortunately, there was not enough sample to process for IF. Try again!
Can I take a look at the Jones Silver stain for this sample?
This stain is unlikely to provide additional helpful information. Pick again!
Can I see an immunohistochemistry (IHC) stain for C4d?
This test can be helpful when looking for evidence of antibody-mediated rejection in a kidney transplant, but probably not that useful here. Pick again!
Which of the following tests will confirm the diagnosis?
Congo Red stain
Perfect! Here it is: 
Masson’s Trichrome stain
This is a stain to visualize the extent of kidney fibrosis. Pick again!
Von Kossa stain
This stain can help identify calcium phosphate stones Pick again!
IHC for SV40
This test can be helpful when looking for eBK nephropathy, most often in a kidney transplant. Pick again!
Lock in your final diagnosis below! (Choose 1):
Myeloma cast nephropathy
Fibrillary glomerulopathy
Immunotactoid glomerulopathy
Smoking-associated nodular glomerulosclerosis
Membranoproliferative glomerulonephritis
IgA nephropathy
Acute interstitial nephritis
Diabetic nephropathy
Hypertensive nephropathy
Light chain proximal tubulopathy
Heavy chain deposition disease
Focal segmental glomerulosclerosis (FSGS)

Click here once you are confident in your final diagnosis!

Case 28 Index
Case 28 Introduction
Case 28 Physical Exam
Case 28 Diagnostic Testing
Case 28 Pathology