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A membranoproliferative pattern of glomerular injury was the predominant pattern of injury in 64% of biopsies as seen in this 52-year-old male (patient 4), with lobular accentuation of the glomerular tuft, mesangial and endocapillary hypercellularity and segmental glomerular basement membrane duplication. Serum protein electrophoresis showed IgG κ, with bone marrow biopsy revealing smoldering myeloma. Three years after presentation, he progressed to ESRD requiring HD.
