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This biopsy was performed on a 66-year-old Caucasian male with a history of hepatitis C, who presented with nephrotic range proteinuria (UPC 4.2 g/g), hematuria and increased creatinine (2.5 mg/dl). C3 is 7 mg/dl and C4 <2 mg/dl. The glomerulus shows a membranoproliferative pattern of glomerular injury characterized by mesangial matrix expansion and hypercellularity, associated with endocapillary proliferation, segmental capillary loop double contour formation and accentuation of the lobular architecture (Fig 1&2). Furthermore, the capillary lumens show frequent, large, PAS-positive pseudothrombi (Fig 1). Immunofluorescence (not shown) is positive in a mesangial and global capillary wall pattern for IgG (1+), IgM...