U Chronic renal failure secondary to ? Hepatitis C. Immunofluorescence IgG Moderate to strong diffuse background. Superimposed nearly confluent peripheral capillary & mesangial granular staining IgA Mild flat background IgM Trace irregular glomerular C3 Nearly confluent fine granular staining with the same distribution as G C1q Negative Kappa Same as C3 Lambda Same as C3 Fibrinogen Moderate interstitial & diffuse glomerular Albumin Moderate background with mild accentuation of glomerular and tubular basement membranes Original Report - Comment Biopsy findings indicate a non-lupus immune complex GN with a diffuse proliferative pattern Differential includes: Post-infectious GN or possibly cryoglobinemic GN Electron Microscopy Irregulary distributed large very electron dense subepithelial deposits with occasional subendothelial deposits In areas where there is an aggregation of subepithelial deposits there is a corresponding accumulation of polymorphs & mononuclear cells on the other side of the basement membrane Patchy moderate effacement of foot processes Diagnosis Diffuse proliferative Glomerulonephritis with ultrastructural features suggesting a post infectious etiology U Biopsy report :post-infectious glomerulonephritis Combined liver kidney transplant September 2001 complicated by recurrent hepatitis C. Planned for antiviral therapy but over the past year. LFTs improved Baseline creatinine 120umol/L rose to 150umol/L in July. Urine trace protein, 6-10 rbc ALT 105 Biopsy done in view of deterioration of renal function Immunofluorescence IgG Mild mesangial staining IgA Moderate mesangial staining IgM Mild mesangial staining C3 Moderate mesangial staining C1q Negative Kappa Mild to moderate mesangial staining Lambda Mild mesangial staining Fibrinogen Mild mesangial staining. Albumin Negative C4d - Negative IgG IgA IgM C3 Kappa Lambda Fibrin Diagnosis: Recurrent or de novo IgA Nephropathy with focal proliferative glomerulonephritis. Possible early chronic transplant glomerulopathy. No definite evidence of acute rejection (G0 CG1 I1 CI1 T0 CT1 V0 CV3 AH1 MM1)