Table 1.
Summary of patient results at presentation
| Type of analysis | Investigations | Measure | Value |
|---|---|---|---|
| Urinalysis | Urine dip | Blood | 2 + |
| Protein | 3 + | ||
| uPCR (mg/mmol) | 1042 | ||
| Blood tests | Hematology | Hemoglobin (g/L) | 119 |
| MCV (fL) | 84 | ||
| White blood cell count (× 109/L) | 9 | ||
| Biochemistry | Creatinine (umol/L) | 140 | |
| eGFR (ml/min) | 44 | ||
| Albumin (g/L) | 17 | ||
| Total Cholesterol (mmol/L) | 9.3 | ||
| Inflammatory markers | Crp (mg/L) | 7 | |
| Infection | Hepatitis A, B, and C serology | −ve | |
| HIV IgG | −ve | ||
| EBV seroloy | Past infection | ||
| CMV serology | Past infection | ||
| Glomerular screen | ANCA | −ve | |
| Anti nuclear antibody | −ve | ||
| Extractable nuclear antigen antibody | −ve | ||
| Double stranded DNA | −ve | ||
| Rheumatoid factor | −ve | ||
| Phospholipase A2 receptor antibody | −ve | ||
| C3 (g/L) | 0.59 | ||
| C4 (g/L) | < 0.02 | ||
| Immunoglobulins | IgG (g/L) | 9.6 | |
| IgG1 (g/L) | 2.94 | ||
| IgG2 (g/L) | 1.74 | ||
| IgG3 (g/L) | 0.85 | ||
| IgG4 (g/L) | 5.29 | ||
| IgA (g/L) | 1.2 | ||
| IgM (g/L) | 0.5 | ||
| Myeloma screen | Protein electrophoresis | No paraprotein | |
| Kappa light chain (mg/L) | 525.4 | ||
| Kappa:lambda light chain ratio | 4.18 | ||
| Lambda light chain (mg/L) | 125.6 | ||
| Histopathology | Renal Biopsy | Light microscopy | Glomeruli: 11, 2 obsolete, remainder hypertrophic or normal |
|
Tubules: mild patchy tubular infiltrate. Focal lymphocytic tubulitis | |||
|
Interstitium: mild patchy scarring, plasma cells noticeable | |||
|
Vessels: intimal thickening of small arteries, no vasculitis | |||
| Immunohistochemistry | Plasma cells in interstitium are IgG4 positive | ||
| Electron microscopy | Podocyte foot process effacement suggesting MCD | ||
| Imaging | Renal USS | Kidney size (cm) | Right 12.2 |
| Kidney Size (cm) | Left 12.1 | ||
| Angiomyolipoma (cm) | 1.5 | ||
| Simple cysts | Some | ||
| Comments | Cortical irregularity | ||
| PET CT | No. and location of nodes | Avid nodes above and below the diaphragm. Consistent with systemic inflammation e.g., IgG4 disease |
uPCR urine protein creatine ratio, MCV mean corpuscular volume, eGFR estimated Glomerular Giltration rate, CRP C-Reactive protein, HIV IgG Human Immunodeficiency Virus Immunoglobulin G, EBV Ebstein Bar Virus, CMV Cytomegalovirus, ANCA Anti-neutrophil cytoplasmic antibody, PET CT Positron emission tomography–computed tomography, MCD minimal change disease, Ig immunoglobulin