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  1. Article ; Online: Membranous Glomerulopathy With Light Chain-Restricted Deposits: A Clinicopathological Analysis of 28 Cases.

    Best Rocha, Alejandro / Larsen, Christopher P

    Kidney international reports

    2017  Volume 2, Issue 6, Page(s) 1141–1148

    Abstract: Introduction: Membranous glomerulopathy (MG) is a common cause of nephrotic syndrome that results from the formation of immune complexes along the subepithelial aspect of the glomerular basement membranes. Although it is most frequently caused by ... ...

    Abstract Introduction: Membranous glomerulopathy (MG) is a common cause of nephrotic syndrome that results from the formation of immune complexes along the subepithelial aspect of the glomerular basement membranes. Although it is most frequently caused by polytypic deposits, cases with light chain isotype-restricted deposits are rarely seen.
    Methods: We conducted a retrospective analysis of 28 cases of MG that showed light chain isotype restriction.
    Results: The mean age at diagnosis was 62.2 years and the male-to-female ratio was 1. All patients presented with proteinuria (73.1% nephrotic range), and the mean serum creatinine was 1.5 mg/dl. Six patients had an underlying lymphoproliferative disorder (LPD), 2 had autoimmune disease, and 1 patient was positive for both hepatitis B and syphilis. Only 1 of the patients with an LPD had a detectable monoclonal Ig. Four patients (14.3%) showed focal proliferation or crescents, 3 of whom had an underlying LPD. Kappa (κ) restriction was seen in 26 of 28 patients (85.7%). Staining for IgG subclasses was performed in 19 cases, 14 of which showed positive staining for a single subclass. PLA2R was positive in 7 of 27 cases. 30% of PLA2R-negative patients and 28.6% of those with positive staining for a single IgG subclass had an associated LPD.
    Discussion: The majority of MG cases with light chain isotype-restricted deposits lack a recognizable secondary etiology. However, the absence of PLA2R positivity, positive staining for a single IgG subclass, and presence of focal proliferation are worrisome histopathologic features that should prompt a thorough clinical workup to exclude the presence of an underlying LPD.
    Language English
    Publishing date 2017-07-29
    Publishing country United States
    Document type Journal Article
    ISSN 2468-0249
    ISSN (online) 2468-0249
    DOI 10.1016/j.ekir.2017.07.008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Clinicopathologic and proteomic characteristics of intratubular cytoplasmic AL amyloidosis.

    Javaugue, Vincent / Rocha, Alejandro Best / Said, Samar M / Santoriello, Dominick / Hou, Jean / Dasari, Surendra / Theis, Jason D / Vrana, Julie A / Batal, Ibrahim / Larsen, Christopher / Markowitz, Glen S / D'Agati, Vivette D / McPhail, Ellen D / Leung, Nelson / Nasr, Samih H

    Kidney international

    2022  Volume 102, Issue 4, Page(s) 926–929

    MeSH term(s) Amyloidosis/pathology ; Humans ; Immunoglobulin Light Chains ; Immunoglobulin Light-chain Amyloidosis/pathology ; Kidney Diseases/pathology ; Multiple Myeloma/pathology ; Proteomics
    Chemical Substances Immunoglobulin Light Chains
    Language English
    Publishing date 2022-08-11
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1016/j.kint.2022.07.020
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: α1-Heavy Chain Deposition Disease With Negative Immunofluorescence Staining on Renal Biopsy.

    Best Rocha, Alejandro / Larsen, Christopher P / Delyria, Paul A / Polavaram, Latha Sree / Said, Samar M / Shibata, Robert S / Rech, Karen L / Nasr, Samih H

    Kidney international reports

    2018  Volume 4, Issue 1, Page(s) 178–183

    Language English
    Publishing date 2018-09-18
    Publishing country United States
    Document type Case Reports
    ISSN 2468-0249
    ISSN (online) 2468-0249
    DOI 10.1016/j.ekir.2018.09.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Genetic testing of complement and coagulation pathways in patients with severe hypertension and renal microangiopathy.

    Larsen, Christopher P / Wilson, Jon D / Best-Rocha, Alejandro / Beggs, Marjorie L / Hennigar, Randolph A

    Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc

    2017  Volume 31, Issue 3, Page(s) 488–494

    Abstract: A diagnosis of thrombotic microangiopathy on kidney biopsy in a patient presenting with hypertensive emergency has historically elicited the diagnosis of malignant hypertension-associated thrombotic microangiopathy. Recent studies, however, have raised ... ...

    Abstract A diagnosis of thrombotic microangiopathy on kidney biopsy in a patient presenting with hypertensive emergency has historically elicited the diagnosis of malignant hypertension-associated thrombotic microangiopathy. Recent studies, however, have raised awareness that a number of these patients may actually represent atypical hemolytic uremic syndrome. To further investigate this premise, we performed next-generation sequencing to interrogate the coding regions of 29 complement and coagulation cascade genes associated with atypical hemolytic uremic syndrome in 100 non-elderly patients presenting with severe hypertension, renal failure and a kidney biopsy showing microangiopathic changes limited to the classic accelerated hypertension-associated lesion of arterial intimal edema ('mucoid intimal hyperplasia') in isolation and without accompanying glomerular microthrombi. No pathogenic or likely pathogenic variants were identified in any of the genes analyzed, although 13 patients had rare variants of uncertain significance predicted to be deleterious by all in-silico prediction methods utilized. Accordingly, this large patient cohort showed no definitive burden of disease secondary to genetic variants involving complement or coagulation pathways, which contrasts sharply with the high frequency of similar mutational events reported for atypical hemolytic uremic syndrome. Our results also inform recent data by suggesting that patients who present with severe or malignant hypertension and renal thrombotic microangiopathy may be at higher risk for atypical hemolytic uremic syndrome only if the biopsy shows more active disease that includes glomerular fibrin thrombi.
    MeSH term(s) Adult ; Atypical Hemolytic Uremic Syndrome/diagnosis ; Atypical Hemolytic Uremic Syndrome/etiology ; Atypical Hemolytic Uremic Syndrome/genetics ; Biopsy ; Complement Pathway, Classical/genetics ; Female ; Genetic Testing ; Humans ; Hypertension/complications ; Hypertension/physiopathology ; Kidney/physiopathology ; Male ; Middle Aged ; Mutation ; Renal Insufficiency/complications ; Thrombotic Microangiopathies/complications ; Thrombotic Microangiopathies/physiopathology
    Language English
    Publishing date 2017-11-17
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 645073-8
    ISSN 1530-0285 ; 0893-3952
    ISSN (online) 1530-0285
    ISSN 0893-3952
    DOI 10.1038/modpathol.2017.154
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Detection of SARS-CoV-2 in formalin-fixed paraffin-embedded tissue sections using commercially available reagents.

    Best Rocha, Alejandro / Stroberg, Edana / Barton, Lisa M / Duval, Eric J / Mukhopadhyay, Sanjay / Yarid, Nicole / Caza, Tiffany / Wilson, Jon D / Kenan, Daniel J / Kuperman, Michael / Sharma, Shree G / Larsen, Christopher P

    Laboratory investigation; a journal of technical methods and pathology

    2020  Volume 100, Issue 11, Page(s) 1485–1489

    Abstract: Coronavirus Disease-19 (COVID-19), caused by the coronavirus SARS-CoV-2, was initially recognized in Wuhan, China and subsequently spread to all continents. The disease primarily affects the lower respiratory system, but may involve other organs and ... ...

    Abstract Coronavirus Disease-19 (COVID-19), caused by the coronavirus SARS-CoV-2, was initially recognized in Wuhan, China and subsequently spread to all continents. The disease primarily affects the lower respiratory system, but may involve other organs and systems. Histopathologic evaluation of tissue from affected patients is crucial for diagnostic purposes, but also for advancing our understanding of the disease. For that reason, we developed immunohistochemical (IHC) and in situ hybridization (ISH) assays for detection of the. virus. A total of eight autopsy lungs, one placenta, and ten kidney biopsies from COVID-19 patients were stained with a panel of commercially available antibodies for IHC and commercially available RNA probes for ISH. Similarly, autopsy lungs, placentas and renal biopsies from non-COVID-19 patients were stained with the same antibodies and probes. All eight lungs and the placenta from COVID-19 patients stained positive by IHC and ISH, while the kidney biopsies stained negative by both methodologies. As expected, all specimens from non-COVID-19 patients were IHC and ISH negative. These two assays represent a sensitive and specific method for detecting the virus in tissue samples. We provide the protocols and the list of commercially available antibodies and probes for these assays, so they can be readily implemented in pathology laboratories and medical examiner offices for diagnostic and research purposes.
    MeSH term(s) Betacoronavirus/isolation & purification ; Female ; Humans ; Immunohistochemistry/methods ; In Situ Hybridization/methods ; Indicators and Reagents ; Kidney/virology ; Lung/virology ; Paraffin Embedding ; Placenta/virology ; Pregnancy ; SARS-CoV-2
    Chemical Substances Indicators and Reagents
    Keywords covid19
    Language English
    Publishing date 2020-07-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80178-1
    ISSN 1530-0307 ; 0023-6837
    ISSN (online) 1530-0307
    ISSN 0023-6837
    DOI 10.1038/s41374-020-0464-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Novel Association of Odontogenic Myxoma with Constitutional Chromosomal 1q21 Microduplication: Case Report and Review of the Literature.

    Best-Rocha, Alejandro / Patel, Kalyani / Hicks, John / Edmonds, Joseph L / Paldino, Michael J / Wu, Hao

    Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society

    2016  Volume 19, Issue 2, Page(s) 139–145

    Abstract: Odontogenic myxoma (OM) is a rare, benign, and locally aggressive tumor. It tends to occur in the posterior maxilla and mandible and is often associated with root resorption and perforation of cortex. Histopathologically, there is a proliferation of ... ...

    Abstract Odontogenic myxoma (OM) is a rare, benign, and locally aggressive tumor. It tends to occur in the posterior maxilla and mandible and is often associated with root resorption and perforation of cortex. Histopathologically, there is a proliferation of spindle, bipolar, and stellate cells, with bland nuclei within a myxoid to infrequently fibromyxoid extracellular matrix. Long, thin residual bony trabeculae are often seen floating within the spindle cell proliferation because of the infiltrating nature of this tumor, and these trabeculae impart a "soap bubble" or "tennis-racket" radiologic appearance. No syndromic association of OM has been reported. Although similar histopathologic features are shared with cardiac myxoma and soft tissue myxoma, mutations in the GNAS gene have not been identified in OM to date, and only 2 of 17 OMs showed mutations in the PRKAR1A gene. In this report, we describe a case of OM in a patient with constitutional 1q21 microduplication, a locus that harbors genes encoding certain proteins in the cAMP-dependent protein kinase A (PKA) signaling pathway, including G-protein-coupled receptors and 1 phosphodiesterase interacting protein. Review of the literature describes the key clinical features and molecular pathogenesis of 1q21 microduplication, as well as highlighting the role of PKA signaling pathway in the pathogenesis of myxomas in general.
    MeSH term(s) Adolescent ; Biomarkers, Tumor/genetics ; Biopsy ; Chromogranins ; Chromosome Duplication ; Chromosomes, Human, Pair 1 ; Cyclic AMP-Dependent Protein Kinase RIalpha Subunit/genetics ; Female ; GTP-Binding Protein alpha Subunits, Gs/genetics ; Genetic Predisposition to Disease ; Humans ; Mutation ; Myxoma/genetics ; Myxoma/pathology ; Myxoma/surgery ; Odontogenic Tumors/genetics ; Odontogenic Tumors/pathology ; Odontogenic Tumors/surgery ; Phenotype ; Predictive Value of Tests ; Risk Factors ; Tomography, X-Ray Computed
    Chemical Substances Biomarkers, Tumor ; Chromogranins ; Cyclic AMP-Dependent Protein Kinase RIalpha Subunit ; PRKAR1A protein, human ; GNAS protein, human (EC 3.6.1.-) ; GTP-Binding Protein alpha Subunits, Gs (EC 3.6.5.1)
    Language English
    Publishing date 2016-03
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 1463498-3
    ISSN 1615-5742 ; 1093-5266
    ISSN (online) 1615-5742
    ISSN 1093-5266
    DOI 10.2350/15-05-1637-CR.1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Detection of SARS-CoV-2 in formalin-fixed paraffin-embedded tissue sections using commercially available reagents

    Best Rocha, Alejandro / Stroberg, Edana / Barton, Lisa M. / Duval, Eric J. / Mukhopadhyay, Sanjay / Yarid, Nicole / Caza, Tiffany / Wilson, Jon D. / Kenan, Daniel J. / Kuperman, Michael / Sharma, Shree G. / Larsen, Christopher P.

    Laboratory Investigation ; ISSN 0023-6837 1530-0307

    2020  

    Keywords Pathology and Forensic Medicine ; Cell Biology ; Molecular Biology ; covid19
    Language English
    Publisher Springer Science and Business Media LLC
    Publishing country us
    Document type Article ; Online
    DOI 10.1038/s41374-020-0464-x
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article: Characteristics of patients with coexisting DNAJB9-associated fibrillary glomerulonephritis and IgA nephropathy.

    Said, Samar M / Rocha, Alejandro Best / Valeri, Anthony M / Sandid, Mohamad / Ray, Anhisekh Sinha / Fidler, Mary E / Alexander, Mariam Priya / Larsen, Christopher P / Nasr, Samih H

    Clinical kidney journal

    2020  Volume 14, Issue 6, Page(s) 1681–1690

    Abstract: Background: Coexistence of fibrillary glomerulonephritis (FGN) and immunoglobulin A (IgA) nephropathy (IgAN) in the same kidney biopsy (FGN-IgAN) is rare, and the clinicopathologic characteristics and outcome of this dual glomerulopathy are unknown.: ... ...

    Abstract Background: Coexistence of fibrillary glomerulonephritis (FGN) and immunoglobulin A (IgA) nephropathy (IgAN) in the same kidney biopsy (FGN-IgAN) is rare, and the clinicopathologic characteristics and outcome of this dual glomerulopathy are unknown.
    Methods: In this study, 20 patients with FGN-IgAN were studied and their characteristics were compared with 40 FGN and 40 IgAN control patients.
    Results: Concurrent IgAN was present in 1.8% of 847 consecutive FGN cases and was the second most common concurrent glomerulopathy after diabetic nephropathy. FGN-IgAN patients were overwhelmingly White (94%) and contrary to FGN patients were predominantly (60%) males. Compared with IgAN patients, FGN-IgAN patients were older, had higher proteinuria, a higher incidence of renal insufficiency, and a lower incidence of microhematuria and gross hematuria at diagnosis. Six (30%) patients had malignancy, autoimmune disease or hepatitis C infection, but none had a secondary cause of IgAN or clinical features of Henoch-Schonlein purpura. Histologically, all cases exhibited smudgy glomerular staining for immunoglobulin G and DnaJ homolog subfamily B member 9 (DNAJB9) with corresponding fibrillary deposits and granular mesangial staining for IgA with corresponding mesangial granular electron-dense deposits. On follow-up (median 27 months), 10 of 18 (56%) FGN-IgAN patients progressed to end-stage kidney disease (ESKD), including 5 who subsequently died. Serum creatinine at diagnosis was a poor predictor of renal survival. The proportion of patients reaching ESKD or died was higher in FGN-IgAN than in IgAN. The median Kaplan-Meier ESKD-free survival time was 44 months for FGN-IgAN, which was shorter than IgAN (unable to compute, P =
    Conclusions: FGN-IgAN is very rare, with clinical presentation and demographics closer to FGN than IgAN. Prognosis is guarded with a median renal survival of 3.6 years. The diagnosis of this dual glomerulopathy requires careful evaluation of immunofluorescence findings, and electron microscopy or DNAJB9 immunohistochemistry.
    Language English
    Publishing date 2020-12-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfaa205
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: APOL1-Associated Collapsing Focal Segmental Glomerulosclerosis in a Patient With Stimulator of Interferon Genes (STING)-Associated Vasculopathy With Onset in Infancy (SAVI).

    Abid, Qassim / Best Rocha, Alejandro / Larsen, Christopher P / Schulert, Grant / Marsh, Rebecca / Yasin, Shima / Patty-Resk, Cathy / Valentini, Rudolph P / Adams, Matthew / Baracco, Rossana

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2019  Volume 75, Issue 2, Page(s) 287–290

    Abstract: Apolipoprotein L1 (APOL1) risk variants G1 and G2 are known to result in risk for kidney disease in patients of African ancestry. APOL1-associated nephropathy typically occurs in association with certain environmental factors or systemic diseases. As ... ...

    Abstract Apolipoprotein L1 (APOL1) risk variants G1 and G2 are known to result in risk for kidney disease in patients of African ancestry. APOL1-associated nephropathy typically occurs in association with certain environmental factors or systemic diseases. As such, there has been increasing evidence of the role of interferon (IFN) pathways in the pathogenesis of APOL1-associated collapsing glomerulopathy in patients with human immunodeficiency virus (HIV) infection and systemic lupus erythematosus, 2 conditions that are associated with high IFN levels. Collapsing glomerulopathy has also been described in patients receiving exogenous IFN therapy administered for various medical conditions. We describe a patient with a genetic condition that results in an increased IFN state, stimulator of IFN genes (STING)-associated vasculopathy with onset in infancy (SAVI), who developed collapsing glomerulopathy during a flare of his disease. The patient was found to have APOL1 G1 and G2 risk variants. This case supports the role of IFN in inducing APOL1-associated collapsing glomerulopathy.
    MeSH term(s) Apolipoprotein L1/genetics ; Apolipoprotein L1/metabolism ; DNA/genetics ; Genotype ; Glomerulosclerosis, Focal Segmental/genetics ; Glomerulosclerosis, Focal Segmental/metabolism ; Glomerulosclerosis, Focal Segmental/pathology ; Humans ; Infant, Newborn ; Interferon Type I/metabolism ; Kidney Glomerulus/ultrastructure ; Male ; Microscopy, Electron ; Vascular Diseases/diagnosis ; Vascular Diseases/etiology ; Vascular Diseases/metabolism
    Chemical Substances APOL1 protein, human ; Apolipoprotein L1 ; Interferon Type I ; DNA (9007-49-2)
    Keywords covid19
    Language English
    Publishing date 2019-10-07
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2019.07.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: The characteristics of patients with kidney light chain deposition disease concurrent with light chain amyloidosis.

    Said, Samar M / Best Rocha, Alejandro / Valeri, Anthony M / Paueksakon, Paisit / Dasari, Surendra / Theis, Jason D / Vrana, Julie A / Obadina, Modupe O / Saghafi, Darius / Alexander, Mariam Priya / Sethi, Sanjeev / Larsen, Christopher P / Joly, Florent / Dispenzieri, Angela / Bridoux, Frank / Sirac, Christophe / Leung, Nelson / Fogo, Agnes B / McPhail, Ellen D /
    Nasr, Samih H

    Kidney international

    2021  Volume 101, Issue 1, Page(s) 152–163

    Abstract: The type of monoclonal light chain nephropathy is thought to be largely a function of the structural and physiochemical properties of light chains; hence most affected patients have only one light chain kidney disease type. Here, we report the first ... ...

    Abstract The type of monoclonal light chain nephropathy is thought to be largely a function of the structural and physiochemical properties of light chains; hence most affected patients have only one light chain kidney disease type. Here, we report the first series of kidney light chain deposition disease (LCDD) concomitant with light chain amyloidosis (LCDD+AL), with or without light chain cast nephropathy (LCCN). Our LCDD+AL cohort consisted of 37 patients (54% females, median age 70 years (range 40-86)). All cases showed Congo red-positive amyloid deposits staining for one light chain isotype on immunofluorescence (62% lambda), and LCDD with diffuse linear staining of glomerular and tubular basement membranes for one light chain isotype (97% same isotype as the amyloidogenic light chain) and ultrastructural non-fibrillar punctate deposits. Twelve of 37 cases (about 1/3 of patients) had concomitant LCCN of same light chain isotype. Proteomic analysis of amyloid and/or LCDD deposits in eight revealed a single light chain variable domain mutable subgroup in all cases (including three with separate microdissections of LCDD and amyloid light chain deposits). Clinical data on 21 patients showed proteinuria (100%), hematuria (75%), kidney insufficiency and nephrotic syndrome (55%). Extra-kidney involvement was present in 43% of the patients. Multiple myeloma occurred in 68% (about 2/3) of these patients; none had lymphoma. On follow up (median 16 months), 63% developed kidney failure and 56% died. The median kidney and patient survivals were 12 and 32 months, respectively. LCDD+AL mainly affected patients 60 years of age or older. Thus, LCDD+AL could be caused by two pathological light chains produced by subclones stemming from one immunoglobulin light chain lambda or kappa rearrangement, with a distinct mutated complementary determining region.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Amyloidosis/complications ; Amyloidosis/diagnosis ; Amyloidosis/pathology ; Female ; Humans ; Immunoglobulin Light Chains ; Kidney/pathology ; Kidney Diseases/complications ; Kidney Diseases/etiology ; Male ; Middle Aged ; Multiple Myeloma/complications ; Proteomics
    Chemical Substances Immunoglobulin Light Chains
    Language English
    Publishing date 2021-11-09
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1016/j.kint.2021.10.019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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