Meet the Editor: Dr. Nicole K. Andeen

Please introduce yourself.

I’m a renal and surgical pathologist at Oregon Health & Science University (OHSU).

Why did you become a pathologist?

As a medical student, I did a pathology student fellowship/post-sophomore fellowship at OHSU, thinking it would enhance my knowledge base for another specialty. Through that hands-on experience, I realized how fun and stimulating pathology was.

What do you like most about being a pathologist?

We are in a position to study a wide spectrum of biology, both neoplastic and nonneoplastic. Subspecialized care has lots of benefits, especially when it doesn’t get too compartmentalized. We have opportunities to learn about diseases and research tools from colleagues in other disciplines that we aren’t directly involved in. For example, medical renal diseases can be secondary to carcinomas, lymphoproliferative disorders, hepatitis, autoimmune diseases, various medications including PD-L1 inhibitors, etc. We can be broadly aware but more narrowly focused.

What is special about your subspecialty?

As a renal pathologist, I regularly think about things I can see, like patterns of injury, immune complex deposition, inflammation, scarring, and structural abnormalities. I also think about things I cannot see directly in a biopsy – metabolic disease, hemodynamic alterations, anatomic abnormalities, autoantibodies, infections, genetics and immune reactions to allogenic stimuli (transplant). I have to integrate what you know and do not know for a meaningful diagnosis. This interaction with complex medical processes and the relationships with nephrologists are very compelling and guarantee a career of lifelong learning!

How does your typical day go?

When on our medical renal service, I assess light and immunofluorescence microscopy from the daily kidney biopsies, and call and discuss the results with the nephrologist. This relationship is very rewarding; even histologically straightforward cases can be clinically complex or atypical, and you can deepen your knowledge on the spectrum of biology from each case. Depending on the week, in the morning I also sign out surgical cases with residents. I usually go for a midday run through the forest trails outside my office. I’m also involved with various research projects and try to make a little progress every day.

What is the most memorable experience you’ve had at work?

I had a very unusual kidney biopsy with distinctive, massive tubular basement immune deposits. I left the dark immunofluorescence room completely baffled at what I’d just seen, unsure if I’d interpreted it correctly. The light microscopic features were similarly confusing, didn’t fit anything I’d seen or heard of before. We treat all kidneys as rush biopsies and call on the same day; so, I called the nephrologist and told him what I saw, but that I had no idea what the diagnosis was, yet.

We deal with lots of gray zones in renal pathology, which keeps you humble, but this was a feeling of complete unknowing, which I have not experienced with a case before or since. To the nephrologist’s great credit, he was comfortable with this uncertainty. It took a few days of additional studies but we eventually made the diagnosis of anti-LRP2 nephropathy/anti-brush border antibody disease. At that time, only 12 cases had been reported since the 1980s. Although rare, more reports have surfaced and it is now better recognized.

What most surprised you about being a pathologist?

As a whole, the clinical and anatomic pathology laboratories provide the majority of diagnostic information for patient care in the US. Thus, although it is a profession of deep-thinking introverts, many of them are well compensated to rise to this more public role.

Is there anything you know now that you wish you had known when you began working as a pathologist?

No. Science is a self-correcting field and I appreciate the opportunity to keep learning.

What do you think you would be doing if you weren’t doing this?

Bike mechanic, repairing fixer-uppers for a new life.

Could you say a few words about your association with PathologyOutlines? is a wonderful, free, encyclopedic resource for pathologists and trainees. I admire the mission of creating and maintaining this multifaceted website, which serves the international pathology community and our patients. I started writing for years ago as a resident, working on kidney tumor chapters with Dr. Maria Tretiakova. I currently work with residents to write and edit medical renal chapters.

You can follow Dr. Andeen’s institution, Oregon Health & Science University, on Twitter at @OHSUNews.

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I have an official degree in Literature and an unofficial degree in life advice. I am also embarking on a life long adventure of travel and experiences. There will be many posts about my experiences abroad, at home, and just thoughts about life. I hope you enjoy my perspective.

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