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

U06-6378#255778770

1. Barclay: 54 yr old maleHx of DM , HTN, CADLiver Tx 2001( Hep C)Admited with CP/CHFBaseline Cr 80This time: Cr 130-160 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 130-160

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

Albumin

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