Dear nephrologist:

Not all #renalpath diagnoses are created equal.

Some are much less than others, and acute tubular injury/ ATN is among the least. Here are the reasons:

1. If we look hard enough, tubular injury is almost always present in the kidney bx. 1/ Tubular injury can be artificially introduced due to poor preservation (if bx isn't placed in formalin quickly) or during tissue processing. So I only begin to look if the creatinine is elevated and there isn't enough interstitial fibrosis/tubular atrophy to account for this 2/

About to give SIU IM Grand Rd on my favorite talk on #onconephrology, a topic that launched my academic career and contains message that more urologists, pathologists, and nephrologists need to hear. Will tweet more slides later There has been a large increase in the incidence of kidney cancer in the last 10 yrs, probably from increased imaging and definitely more detection of T1 tumors