Jonathan Zuckerman MD PhD
@jzrenalpath.bsky.social
Service Chief, Renal Pathology, UCLA Department of Pathology and Laboratory Medicine. Views are my own.
Intimate contact between endothelial cell and mesangial cell cytoplasm. A reminder that no GBM separates the blood space from the mesangium. I wonder what secrets they are sharing. #renalpath #pathsky #nephsky
October 31, 2025 at 5:09 PM
Intimate contact between endothelial cell and mesangial cell cytoplasm. A reminder that no GBM separates the blood space from the mesangium. I wonder what secrets they are sharing. #renalpath #pathsky #nephsky
Severe vascular rejection hiding in the IF tissue. Fibrinoid necrosis really pops on the H&E and further confirmed by fibrinogen IF. #renalpath #pathsky #nephsky
October 31, 2025 at 5:04 PM
Severe vascular rejection hiding in the IF tissue. Fibrinoid necrosis really pops on the H&E and further confirmed by fibrinogen IF. #renalpath #pathsky #nephsky
Teenager with nephrotic syndrome. Biopsy revealed unusual case of membranous nephropathy in a peds patient. PLA2R positive (IHC). PLA2R most common antigen in peds MN. EXT1/2 also common, SEMA3B less common. (pubmed.ncbi.nlm.nih.gov/38025223/) #renalpath #pathsky #nephsky
October 13, 2025 at 1:56 PM
Teenager with nephrotic syndrome. Biopsy revealed unusual case of membranous nephropathy in a peds patient. PLA2R positive (IHC). PLA2R most common antigen in peds MN. EXT1/2 also common, SEMA3B less common. (pubmed.ncbi.nlm.nih.gov/38025223/) #renalpath #pathsky #nephsky
A startling biopsy. Severe acute TMA in a pt with suspected scleroderma renal crisis. Massive vascular thrombosis, mucoid intimal edema, and early onion skin change associated with severe cortical necrosis. #renalpath #nephsky #pathsky
October 9, 2025 at 3:08 AM
A startling biopsy. Severe acute TMA in a pt with suspected scleroderma renal crisis. Massive vascular thrombosis, mucoid intimal edema, and early onion skin change associated with severe cortical necrosis. #renalpath #nephsky #pathsky
Bx for nephrotic syndrome in an IV drug user with multiple infections. LM was all medulla, but good enough to make a diagnosis. AA amyloidosis; very common bx result in this clinical setting. #renalpath #pathsky #nephsky
October 7, 2025 at 5:32 PM
Bx for nephrotic syndrome in an IV drug user with multiple infections. LM was all medulla, but good enough to make a diagnosis. AA amyloidosis; very common bx result in this clinical setting. #renalpath #pathsky #nephsky
Bx for new onset NS in an older adult. Serologic work up including SPEP/UPEP IFE negative. Bx shows membranous pattern with few double contours. IgG3-k restriction and mottle EM deposits c/w PGNMID with membranous predominant pattern. PLA2R- #renalpath #pathsky #nephsky
October 5, 2025 at 3:30 PM
Bx for new onset NS in an older adult. Serologic work up including SPEP/UPEP IFE negative. Bx shows membranous pattern with few double contours. IgG3-k restriction and mottle EM deposits c/w PGNMID with membranous predominant pattern. PLA2R- #renalpath #pathsky #nephsky
Kidney txp biopsy for AKI (~6 post txp). Tubular injury associated with granular and ropey trichome positive casts. IHC confirmed myoglobin cast nephropathy. CK found to be very high; thought to be due to statin related myopathy. #renalpath #pathsky #nephsky
October 4, 2025 at 5:17 PM
Kidney txp biopsy for AKI (~6 post txp). Tubular injury associated with granular and ropey trichome positive casts. IHC confirmed myoglobin cast nephropathy. CK found to be very high; thought to be due to statin related myopathy. #renalpath #pathsky #nephsky
Heavy Chains, Heavy Consequences: A Case of Concomitant Heavy Chain Amyloidosis and Heavy Chain Deposition Disease. Fibrils and powdery deposits. #renalpath #nephsky #pathsky www.sciencedirect.com/science/arti...
September 17, 2025 at 6:13 PM
Heavy Chains, Heavy Consequences: A Case of Concomitant Heavy Chain Amyloidosis and Heavy Chain Deposition Disease. Fibrils and powdery deposits. #renalpath #nephsky #pathsky www.sciencedirect.com/science/arti...
September 11, 2025 at 5:44 PM
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 #nephsky #pathsky
September 11, 2025 at 5:21 PM
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 #nephsky #pathsky
Lupus nephritis case with prominent podocyte cytoplasmic vacuolization on LM with myelin figures revealed by EM. Probably HCQ effect but given its prominence genetic etiologies should be excluded (e.g., Fabry, LMX1B). #renalpath #pathsky #nephsky
September 8, 2025 at 11:06 PM
Lupus nephritis case with prominent podocyte cytoplasmic vacuolization on LM with myelin figures revealed by EM. Probably HCQ effect but given its prominence genetic etiologies should be excluded (e.g., Fabry, LMX1B). #renalpath #pathsky #nephsky
Interesting case of AL-amyloidosis. Massive vascular deposits, even in hilar arterioles with glomerular sparring. Patient had minimal proteinuria given lack of glomerular amyloid. #renalpath #pathsky #nephsky
September 4, 2025 at 11:14 PM
Interesting case of AL-amyloidosis. Massive vascular deposits, even in hilar arterioles with glomerular sparring. Patient had minimal proteinuria given lack of glomerular amyloid. #renalpath #pathsky #nephsky
August 28, 2025 at 10:06 PM
Nice example of urate crystals in gouty tophi involving the medulla. Polarizable crystals can be see using unstained sections from the IF tissue. #renalpath #pathsky #nephsky
August 28, 2025 at 7:04 PM
Nice example of urate crystals in gouty tophi involving the medulla. Polarizable crystals can be see using unstained sections from the IF tissue. #renalpath #pathsky #nephsky
Another example of an 'incidental' finding next to the tumor in a nephrectomy specimen. Amyloidosis (probably LECT2). Reminder not too overlook the non-neoplastic tissue. #renalpath #pathsky #nephsky
August 20, 2025 at 4:55 PM
Another example of an 'incidental' finding next to the tumor in a nephrectomy specimen. Amyloidosis (probably LECT2). Reminder not too overlook the non-neoplastic tissue. #renalpath #pathsky #nephsky
Multi-focal severe necrotizing arteritis in a kidney biopsy with an ANCA vasculitis. Interestingly, foci of arteritis were only present in IF/EM tissue. Illustrating how even when severe arteritis can be easily missed due to sampling in a small biopsy. #renalpath #nephsky #pathsky
August 15, 2025 at 3:35 PM
Multi-focal severe necrotizing arteritis in a kidney biopsy with an ANCA vasculitis. Interestingly, foci of arteritis were only present in IF/EM tissue. Illustrating how even when severe arteritis can be easily missed due to sampling in a small biopsy. #renalpath #nephsky #pathsky
Kidney txp biopsy with histologic features of acute pyelonephritis. Neutrophilic tubulitis, neutrophilic casts, and tubules which seem to explode out. Cellular rejection typically is not neutrophilic and inflammation hits the tubules from the outside in. #renalpath #nephsky #pathsky
August 11, 2025 at 5:28 PM
Kidney txp biopsy with histologic features of acute pyelonephritis. Neutrophilic tubulitis, neutrophilic casts, and tubules which seem to explode out. Cellular rejection typically is not neutrophilic and inflammation hits the tubules from the outside in. #renalpath #nephsky #pathsky
these are the areas I am referring to in the EM in one image. Not super specific, but could be the correlate for your IF staining.
August 10, 2025 at 8:15 PM
these are the areas I am referring to in the EM in one image. Not super specific, but could be the correlate for your IF staining.
Wide variety of morphologies in this case of crystalline light chain proximal tubulopathy: mottle lysosomes, crystals, and fibrils. #renalpath #nephsky #pathsky
August 6, 2025 at 9:32 PM
Wide variety of morphologies in this case of crystalline light chain proximal tubulopathy: mottle lysosomes, crystals, and fibrils. #renalpath #nephsky #pathsky
One of the more subtle amyloid cases I have seen. Just a few deposits in 2 gloms by LM. Just enough congo red staining. Glad to catch it in the EM as well. #renalpath #nephsky #pathsky
July 31, 2025 at 6:19 PM
One of the more subtle amyloid cases I have seen. Just a few deposits in 2 gloms by LM. Just enough congo red staining. Glad to catch it in the EM as well. #renalpath #nephsky #pathsky
Some well formed "eye lashes" on these capillary loops in a case of AL-amyloidosis. Podocytes getting skewered by the spicules in the EM. #renalpath #pathsky #nephsky.
July 24, 2025 at 10:21 PM
Some well formed "eye lashes" on these capillary loops in a case of AL-amyloidosis. Podocytes getting skewered by the spicules in the EM. #renalpath #pathsky #nephsky.
Classic example of Alport spectrum disease in a patient with X-linked Alport syndrome. Lesions of segmental glomerulosclerosis, numerous interstitial foam cells, and atypical GBMs with lamina densa splitting, subepithelial scalloping, and thinning. #renalpath #pathsky #nephsky
July 24, 2025 at 10:15 PM
Classic example of Alport spectrum disease in a patient with X-linked Alport syndrome. Lesions of segmental glomerulosclerosis, numerous interstitial foam cells, and atypical GBMs with lamina densa splitting, subepithelial scalloping, and thinning. #renalpath #pathsky #nephsky
Some nice examples of severe tubulitis in this case of ACR 1B. Interestingly bx for new de novo DSA with with stable allograft function (~1 year post txp). No significant MVI. #renalpath #nephksy #pathsky
July 17, 2025 at 3:50 PM
Some nice examples of severe tubulitis in this case of ACR 1B. Interestingly bx for new de novo DSA with with stable allograft function (~1 year post txp). No significant MVI. #renalpath #nephksy #pathsky
Case of IgAN in the setting cirrhosis with prominent red blood cell casts with fairly focal crescents. Pt was biopsied for gross hematuria. #renalpath #pathsky #nephsky
June 23, 2025 at 3:25 PM
Case of IgAN in the setting cirrhosis with prominent red blood cell casts with fairly focal crescents. Pt was biopsied for gross hematuria. #renalpath #pathsky #nephsky
Nice example of cryoGN in a Sjogren pt. Somewhat early kidney presentation with some active crescents without well-developed MPGN features. IgM-k dominant, less IgG/L (type II cryo). Cryo plugs in vessels. Great micro-tubles by EM. #renalpath #nephksy #pathsky
June 20, 2025 at 4:32 PM
Nice example of cryoGN in a Sjogren pt. Somewhat early kidney presentation with some active crescents without well-developed MPGN features. IgM-k dominant, less IgG/L (type II cryo). Cryo plugs in vessels. Great micro-tubles by EM. #renalpath #nephksy #pathsky