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Kidney Bx. Patient has monoclonal immunoglobulin deposition disease (MIDD). #electronmicroscopy shows a macrophage in close apposition with a tubular basement membrane (TBM). The macrophage appears to be processing the powdery 'punctate' electron-dense deposit within the TBM.

#askrenal Tiffany Caza Lynn D. Cornell, M.D. Child w heart tx. Native kidney bx. Proteinuria + hematuria. C3 + C4 (N), anti-GBM (+), dsDNA (-), cryo (-), Congo Red (-), DNAJB9 (-), IgG 1-2+ linear, C3 (weak). EM: focal subepithelial organized dep in a membranous pattern. Occ TRI. Any ideas?

Kidney Bx #electronmicroscopy shows tubular epithelium. What's going on with the mitochondria? It looks like the mitochondrion is being internalised within a phagophore. You can see the cristae being 'sucked in' to the structure. I interpret this as mitophagy - is this correct?

#askrenalpath Astrid Weins Do patients with anti-nephrin autoantibodies still show slit diaphragms between intact podocyte foot processes by #electronmicroscopy?

Are there any diseases that cause proliferation of the neuromuscular junction?

Alveolar Soft Part Sarcoma Has any progress been made in uncovering the histogenesis of this tumour?

Please consider attending the UltraPath XXI electron microscopy conference in beautiful Manly Beach, Sydney, Sep 30 to Oct 4, 2024. Lots of interesting ultrastructural pathology with presentations by world leaders in the field. Plus great social events. ultrapath.org

Seeking opinions on this subendothelial material. Native Renal Bx. Male in 60s w hematuria + proteinuria. LM shows an MPGN w focal vasculitis. EM is from the paraffin block - occasional loops occluded. IF - focal staining for fibrinogen. ? cryofibrinogen #askrenal Sanjeev Sethi

Seeking opinions for a differential on this appearance by #electronmicroscopy. Native Renal Bx, male in 30s. My thoughts are LCAT Deficiency or Alagille Syndrome. Any others? - ? hepatic glomerulosclerosis. Pt has low HDL. #askrenal Sanjeev Sethi Anthony Chang, MD (張賀文) Jonathan Zuckerman MD PhD

Renal Bx, female in 40s. TBMs focally expanded by fibrils measuring 12-13nm in diameter. I see this occasionally by EM in renal biopsies and never know if it's amyloid or a mimic (similar to diabetic fibrillosis in mesangial matrix). No amyloid in gloms. Congo Red not done ATM.

Are Langerhans histiocytes a normal component of the renal tubular epithelium? We have patient w uveitis + minimal inflammatory infiltrate on renal bx. EM shows structures that look like Birbeck granules (arrows). Could the presence of Langerhans cells indicate anything?#askrenal

Last chance to register for the Electron Microscopy Tutorial Day & UltraPath XXI Conference, Sep 30-Oct 4. You can't beat the location. Follow the pink arrow and you'll find us discussing ultrastructural pathology at Circular Quay in the heart of Sydney. ultrapath.org

Native kidney bx of a 50M w psoriasis. @electronmicroscopy shows membranous nephropathy (MN). Is there a relationship between psoriasis and MN? Could there be a PLA2 receptor auto-antibody that attacks both keratinocytes in skin + podocytes in glomeruli? Sanjeev Sethi #askrenal

Patient w membranous nephropathy. #electronmicroscopy shows electron-dense deposits (arrow) lining Bowman's capsule (BC) at the vascular pole, but deposits are not evident further along BC. Presumably the transition point between #podocyte and parietal epithelial cell phenotypes.

Kidney Bx. Looking for an infective agent by #electronmicroscopy. Found these structures that can be misinterpreted as viruses. They are nuclear pores. The plane of section has tangentially traversed the edge of a nucleus.

Native Kidney Bx #electronmicroscopy. #askrenal Any thoughts on these electron-dense structures? I interpret them as karyorrhectic debris. I see them rarely but have never seen them documented in an illustration. Interestingly this patient has 1+ C1q in capillary walls.

#electronmicroscopy Kidney bx shows a membranous nephropathy. #podocytes, typically post-mitotic, appear to be trying to divide. Nuclei are bi-lobed with narrow chromatin bridges. Cells are rounded with blebs + detachment from the GBM. Possibly an example of mitotic catastrophe.

#askrenal Can a plasmacytoma produce anti-LCAT autoantibodies? We have a case of a patient with a plasmacytoma. However, by #electronmicroscopy, the glomerular ultrastructure suggests LCAT deficiency.