Clinical Case: Nephrotic Syndrome

A 58 y/o F with history of HTN presents to an outside hospital for pancreatitis and LE edema. While there patient is found to have Hep C (genotype 3). After protracted course due to no improvement in pancreatitis she is transferred to our hospital. While here, a UA is done which shows 3+ proteins and many RBCs. Urinary protein is quantified and the patient is found to have 16g/day. Complements and ANA/Anti-DS DNA are done: Low C3 and very low C4, postivie ANA 1:320 and no anti-DS DNA. IgG4 level is within normal limits. Rheumatoid factor was order and found to be negative, while cryoglobulins are still being. A renal biopsy is done shortly thereafter and the LM is shown below (EM and IF are pending). On exam she has 3+ edema, no lymphadenopathy, no rash on her face, and livedo reticularis rash on LE bilaterally. Otherwise exam is unremarkable.

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 What is the most likely diagnosis?





E.) IgG4 related kidney disease


Nice job!
You now have 30 beans.
Use them wisely, my friend.

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