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U99-12620

U99-12620. Chronic renal failure secondary to ? Hepatitis C. Immunofluorescence. IgG – Moderate to strong diffuse background. Superimposed nearly confluent peripheral capillary & mesangial granular staining IgA – Mild flat background IgM – Trace irregular glomerular

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U99-12620

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  1. U99-12620 • Chronic renal failure secondary to ? Hepatitis C.

  2. Immunofluorescence • IgG – Moderate to strong diffuse background. Superimposed nearly confluent peripheral capillary & mesangial granular staining • IgA – Mild flat background • IgM – Trace irregular glomerular • C3 – Nearly confluent fine granular staining with the same distribution as G • C1q – Negative • Kappa – Same as C3 • Lambda – Same as C3 • Fibrinogen – Moderate interstitial & diffuse glomerular • Albumin – Moderate background with mild accentuation of glomerular and tubular basement membranes

  3. Original Report - Comment • Biopsy findings indicate a non-lupus immune complex GN with a diffuse proliferative pattern • Differential includes: Post-infectious GN or possibly cryoglobinemic GN

  4. Electron Microscopy • Irregulary distributed large very electron dense subepithelial deposits with occasional subendothelial deposits • In areas where there is an aggregation of subepithelial deposits there is a corresponding accumulation of polymorphs & mononuclear cells on the other side of the basement membrane • Patchy moderate effacement of foot processes

  5. Diagnosis • Diffuse proliferative Glomerulonephritis with ultrastructural features suggesting a post infectious etiology

  6. U05-16833 • Biopsy report :post-infectious glomerulonephritis • Combined liver kidney transplant – September 2001 complicated by recurrent hepatitis C. • Planned for antiviral therapy but over the past year. LFTs improved • Baseline creatinine 120umol/L rose to 150umol/L in July. Urine trace protein, 6-10 rbc ALT 105 • Biopsy done in view of deterioration of renal function

  7. Immunofluorescence • IgG – Mild mesangial staining • IgA – Moderate mesangial staining • IgM – Mild mesangial staining • C3 – Moderate mesangial staining • C1q – Negative • Kappa – Mild to moderate mesangial staining • Lambda – Mild mesangial staining • Fibrinogen – Mild mesangial staining. • Albumin – Negative • C4d - Negative

  8. IgG

  9. IgA

  10. IgM

  11. C3

  12. Kappa

  13. Lambda

  14. Fibrin

  15. Diagnosis: • Recurrent or de novo IgA Nephropathy with focal proliferative glomerulonephritis. • Possible early chronic transplant glomerulopathy. • No definite evidence of acute rejection • (G0 CG1 I1 CI1 T0 CT1 V0 CV3 AH1 MM1)

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