PathWays Case Study: June 23

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The glomerulus demonstrates mesangial matrix expansion with PAS positive material and mesangial hypercellularity. Segmental double contours are seen.

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Randomly oriented, loosely arranged, non-branching fibrils are seen in an amorphous background. The average fibril size was 15 nm.

A middle-aged woman presented with worsening renal function, hematuria, and nephrotic range proteinuria. Investigations were significant for an IgG kappa monoclonal protein. Serological studies were negative for hepatitis C antibody, ANA, and antibodies to myeloperoxidase (MPO) and proteinase 3 (PR3).  Immunofluorescence microscopy (IF) studies demonstrated smudgy staining of the capillary loops and mesangium with IgG (3+), C3 (3+), and kappa (3+) and lambda light chains ( 3+). IgG subclass studies demonstrated strong staining with IgG4 and IgG1. No extraglomerular deposits were noted.

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Dr. Mariam (Priya) Alexander

Mariam (Priya) Alexander, M.D.
Senior Associate Consultant, Division of Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine

apriljosselyn

April Josselyn

April Josselyn is a Marketing Associate at Mayo Medical Laboratories. She is the editor of Mayo Clinic PathWays and supports corporate communications strategies and internal communications. She has worked at Mayo Clinic since 2012. Outside of work, April enjoys the outdoors and being "hockey mom" for her two sports-crazed boys.

Responses

Very good information.look forward to more case studies

good case than you

Very nice case. Thank you.

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