Direct immunofluorescence (IF) on frozen tissue is the method of choice for the study of medical renal diseases. When no glomeruli are available, IF can be performed on the formalin-fixed paraffin-embedded tissue allocated for light microscopy after antigen retrieval with proteases. In this study, the results of IF on frozen tissue (IF-F) and on deparaffinized, pronase-treated tissue (IF-P) were compared in 71 renal biopsies representing 12 major renal diseases. Using IF-P, diagnostic findings were obtained in 100% of cases of lupus nephritis, acute post-infectious glomerulonephritis, cryoglobulinemic glomerulonephritis, fibrillary glomerulonephritis, primary amyloidosis, myeloma cast nephropathy, and light-chain Fanconi syndrome (LCFS), 88% of cases of immunoglobulin (Ig)A nephropathy, 80% of cases of light-chain deposition disease, 60% of cases of membranoproliferative glomerulonephritis type 1, 50% of cases of idiopathic membranous glomerulopathy (MGN) and 20% of cases of anti-glomerular basement membrane (GBM) disease. IF-P was less sensitive than IF-F for the detection of C3 in all disease categories and for the detection of IgG in cases of MGN and anti-GBM disease. The diagnostic kappa light-chain staining was demonstrated in 100% of cases of LCFS by IF-P versus 40% by IF-F. We conclude that IF-P is a valuable salvage immunohistochemical technique for renal biopsies lacking adequate cortical sampling for IF-F, and is superior to IF-F for the diagnosis of LCFS.

A 26-year-old female was found to have renal insufficiency on routine laboratory studies. She denied gross hematuria, edema, or oliguria. She had no history of diabetes, hypertension, arthritis, urinary tract infections, or nephrolithiasis. Her only medication was an oral contraceptive (Lo/Ovral). On physical examination, the patient had blood pressure of 120/66 mm Hg, heart rate of 70 per min, and weight of 146 lb. Cardiovascular, pulmonary, and abdominal examinations were unremarkable. There was no evidence of rash or edema. Laboratory examination showed a total leukocyte count of 7000/mm 3 (normal range 4000-9000/mm 3 ), hematocrit 39.8% (normal range 33.0-45.0%), platelet count 242 Â 10 9 /l (normal range 140-360 Â 10 9 /l), 24-h urine protein 70 mg, serum albumin 4.3 g per 100 ml (43 g/L) (normal range 3.2-5.2 g per 100 ml (32-52 g/L)), serum creatinine 1.6 mg per 100 ml (141 mmol/L), creatinine clearance 71 ml/min, and serum cholesterol 222 mg per 100 ml (5.74 mmol/L). Serum electrolytes were normal including sodium, potassium, glucose, bicarbonate, and calcium. The patient had normal serum complements. The following serologies were negative: antinuclear antibody, antidouble-stranded DNA antibody, antineutrophil cytoplasmic antibody, hepatitis B surface antigen, and hepatitis C antibody. Urinalysis showed specific gravity 1.010, pH 5.0 and was negative for protein, blood, glucose, and nitrite. Microscopic examination of the urine revealed 0-5 white blood cells per high-power field, no red blood cells, and no hyaline or granular casts. Renal ultrasound showed normal-sized kidneys with normal echogenicity and no hydronephrosis, masses, or cysts. A renal biopsy was performed.

Bladder cancer (BC) is the most common cancer of the urinary tract in the United States. Imaging plays a significant role in the management of patients with BC, including the locoregional staging and evaluation for distant metastatic disease, which cannot be assessed at the time of cystoscopy and biopsy/resection. We aim to review the current role of cross-sectional and molecular imaging modalities for the staging and restaging of BC and the potential advantages and limitations of each imaging modality. CT is the most widely available and frequently utilized imaging modality for BC and demonstrates good performance for the detection of nodal and visceral metastatic disease. MRI offers potential value for the locoregional staging and evaluation of muscular invasion of BC, which is critically important for prognostication and treatment decision-making. FDG-PET/MRI is a novel hybrid imaging modality combining the advantages of both MRI and FDG-PET/CT in a single-setting comprehensive staging examination and may represent the future of BC imaging evaluation.

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OBJECTIVE The objective of our study was to evaluate whether facial and chest photographs obtained simultaneously with radiographs increase radiologists’ detection rate of labeling errors. MATERIALS AND METHODS We obtained simultaneous portable radiographs and photographs of 34 patients. We generated 88 pairs of chest radiographs (one recent radiograph, one prior radiograph) and compiled a set of 20 pairs for reader review. Two, three, or four mismatched pairs (i.e., pairs containing radiographs of different patients) were introduced into each list. Ten radiologist readers blinded to the presence of mismatches interpreted the 20 radiograph pairs. Readers then reviewed a second set of 20 pairs containing mismatches but photographs of the patients obtained at the time of imaging were attached to the radiographs. Readers were not instructed regarding the purpose of the photographs. The mismatch detection rate and time for interpretation was recorded for both sessions. The two-tailed Fisher exact test was used to evaluate differences in mismatch detection rates between sessions, with a p value of less than 0.05 being considered significant. RESULTS The error detection rates without (3/24 = 12.5%) and with (16/25 = 64%) photographs significantly differed (p = 0.0003). The average interpretation times without and with photographs were 35.73 and 26.51 minutes, respectively (two-tailed Student t test, p = 0.1165). CONCLUSION The use of photographs increased the detection of errors without a concomitant increase in film interpretation time, which may translate into improvements in patient safety without an increase in interpretation time.