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July 7, 2017

Fibrillary Glomerulopathy

Commonly heard after we give the diagnosis: “I heard about this in Fellowship”…

This 62-year-old African-American just completed treatment for hepatitis C with HARVONI® (ledipasvir 90 mg/sofosbuvir 400 mg). He was found to have an elevated creatinine of 1.8 mg/dl (baseline 1.1 mg/dl). Urinalysis showed 3+ protein with no blood and no casts. He also has well-controlled hypertension for more than 10 years.

1. Glomerulus with diffuse mesangial expansion (PAS x400)
2. IgG predominantly mesangial but with extension into loops (200x)
3. Mesangial and loop fibrillary deposits (EM 4,000x)
4. Mesangial and loop fibrillary deposits (EM 12,000x.)

Diagnosis: Fibrillary Glomerulopathy