arrow-right-realarrow-right-whitearrow-rightback-to-topdoctordownloadfacebookinstagramlogo-markerlogo-wordmarkpodcastsearchsearch_whitetwitter
Close Modal

Blog


Currently filtering by tag: MPGN

Diagnose This (August 5, 2019)

What is this finding in this native kidney?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​...

When Lightning Strikes Twice

This biopsy came to us for a workup on proteinuria.  The patient is a 68-year-old female with a history of “low-grade non-Hodgkin’s lymphoma” initially diagnosed in 2007. She was treated with rituximab, from November 2007 to July 2009.  She was treated with Treanda (bendamustine ) during the spring of 2010.  In 2010, she presented with proteinuria and a renal biopsy established the diagnosis of membranoproliferative glomerulonephritis (MPGN).  Her symptoms resolved with chemotherapy and lymphoma treatment and remission.  She now presents once again with proteinuria. The patient is in remission from the lymphoma. A renal biopsy was performed to establish the cause...

Pushing Glass (March 13, 2018)

A 65-year-old male presents with mild proteinuria and a sudden increase in creatinine. He was recently diagnosed with widely metastatic gastric carcinoma and has received 4 rounds of chemotherapy. During treatment with chemotherapy, his creatinine increased to 3.5 and has remained at that level despite fluid resuscitation. A kidney biopsy is performed. What is the best diagnosis? A. Membranoproliferative Glomerulonephritis B. Metastatic Gastric Carcinoma C. Intravascular Diffuse Large B-Cell Lymphoma D. Thrombotic Microangiopathy The best answer is C – Intravascular Diffuse Large B-Cell Lymphoma This is a very difficult case due to the proliferative nature of the glomeruli. At first...

Membranoproliferative Glomerulonephritis Pattern

This glomerulus shows a membranoproliferative glomerulonephritis (MPGN) pattern of injury. To a large extent, the etiologic differential diagnosis depends on the immunofluorescence and ultrastructural findings. This light microscopic pattern of injury may be seen in one of the so-called C3 glomerulopathies, in MPGN with immune complexes (no known clinical cause), or in so-called "secondary" forms of MPGN in patients who have underlying infection, autoimmune disease, or dysproteinemia. Identifying the pattern of injury is only the beginning of the workup in many cases!

Hep C-Associated Cryoglobulinemic Glomerulonephritis

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...

Monoclonal Gammopathy of Renal Significance

The renal biopsy shown here has an MPGN pattern of injury by light microscopy. Routine immunofluorescence on the fresh (unfixed) tissue is negative for immune reactants but repeat staining on the formalin fixed paraffin embedded tissue after protease retrieval shows positive staining for IgG and kappa. A subsequent bone marrow biopsy revealed a small clonal B-cell population. A recent case series (see reference below) detailed a cohort of patients with renal biopsy findings similar to those shown here, namely an MPGN pattern by LM and false negative staining for immunoglobulins by routine IF that are ‘unmasked monoclonal deposits’ by performing IF...

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

This renal biopsy was taken from an 82-year-old man with acute renal failure and nephrotic range proteinuria. His past medical history included chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). The biopsy shows an involvement of the renal cortex by a monomorphic population of small lymphoid cells, the morphology and immunophenotype of which were diagnostic of CLL/SLL. In addition, glomeruli showed a diffuse membranoproliferative glomerulonephritis (MPGN) pattern of injury with associated immune deposits. In a study by Da’as et al., more than 10% of patients with non-Hodgkin lymphoma developed acute renal failure. More recent work by Kowalewska et al. describes the spectrum...

Proliferative Glomerulonephritis with Monoclonal IgG Deposits

The glomerulus pictured for light microscopy shows membranoproliferative changes with mesangial hypercellularity, GBM duplication, and endocapillary proliferation. There is light chain-restricted staining for IgG kappa by immunofluorescence. The deposits were immune complex-type by electron microscopy (not pictured). The findings in this biopsy are consistent with the entity known as proliferative glomerulonephritis with monoclonal IgG deposits. A case series detailed the clinical findings in 37 patients with proliferative glomerulonephritis with monoclonal IgG deposits and found the underlying etiology was undetermined in the majority of cases. Most did not appear to be related to infection, autoimmune-related disease or hematologic malignancy (see reference below)....