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 |