54 year old man with 7 grams/day proteinuria Microscopic hematuria and serum creatinine nearly 130. He is HCV positive and had received liver transplant.

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Presentation transcript:

54 year old man with 7 grams/day proteinuria Microscopic hematuria and serum creatinine nearly 130. He is HCV positive and had received liver transplant. Cryoglobulins are positive. Complements C3&C4 normal U #

1. Barclay: 54 yr old male Hx of DM, HTN, CAD Liver Tx 2001( Hep C) Admited with CP/CHF Baseline Cr 80 This time: Cr U/A: 3+ ptn, 1+ Hb, hyaline casts, some granular casts Ptn/Cr 616 mg/mmol Hb: 93, WBC: 5.2, Plts: 49 T.Ptn: 48, Alb: 31. SPEP, UPEP: nephrotic synd pattern C3, C4 : Normal, ANA: Negative Cryoglobulins: positive Cryo electrophoresis: type 2 cryo 54 yr old male Hx of DM, HTN, CAD Liver Tx 2001( Hep C) Admited with CP/CHF Baseline Cr 80 This time: Cr U/A: 3+ ptn, 1+ Hb, hyaline casts, some granular casts Ptn/Cr 616 mg/mmol Hb: 93, WBC: 5.2, Plts: 49 T.Ptn: 48, Alb: 31. SPEP, UPEP: nephrotic synd pattern C3, C4 : Normal, ANA: Negative Cryoglobulins: positive Cryo electrophoresis: type 2 cryo

IgG-negative IgA- negative IgM- mild mesangial staining C3- negative C1q-negative Kappa-negative Lambda-negative Fibrin- mild to moderate interstitial staining Albumin- moderate hyaline droplet change in tubular cytoplasm,hyaline droplet in podocytes. IF

IgM

C3

Fibrin

Albumin

Diagnosis: Renal Biopsy: Chronic advanced membranoproliferative glomerulonephritis with features suggestive of cryoglobulinemic glomerulonephritis.