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Advanced Nephrology Course 2020
Prof Ian Roberts & Dr Maria Soares


Case 1
Female, 81 yo. T2DM for 15 years but no retinopathy. AF on apixaban. HTN on atenolol and furosemide. Cr 180. Unwell; GP found Cr to be now 440. Recent diarrhoea. Dip trace blood and trace protein. Acute screen unhelpful - mild eosinophilia since last year.
IF: Negative for IgA, IgG, IgM, C3, C1q, kappa and lambda.
EM: not performed.
H&E provided.
case 1 H&E
Diagnosis & discussion [0]
Case 2

Female, 62 years. Sjogrens, seronegative rheumatoid arthritis, new purpuric rash recently. Low C3 and C4, cryos negative. Increased creatinine. Low grade proteinuria. PCR 22. Recent NSAIDS and flucloxacillin.

IF: IgG, IgM see images. C3, Kappa and Lambda light chains as IgM. IgA negative. Trace C1q.

Case 2 H&E
Case 2 silver
Case 2 IgG
Case 2 IgM
case 2 EM
Diagnosis & discussion [0]
Case 3

Male, 54 years. Type 2 DM diagnosed 3 years ago. Normal renal function. 3/12 ago presented with AKI, urea 30, Cr 700 with 1 week history of feeling unwell, feverish. Currently anuric, blood and protein in urine. Left foot ulcer ?osteomyelitis.

IF: IgG, IgA, C3 see images. Kappa and lambda as IgG. IgM and C1q trace positivity.

Case 3 H&E
Case 3 silver
Case 3 IgG
Case 3 IgA
Case 3 C3
Diagnosis & discussion [0]
Case 4

Female, 71 years. Multifocal lesions on brain MRI + confusion. Protein and blood in urine. Kidney heterogenous on CT scan. ANCA/antiGBM negative.

IF: Negative for IgG, IgA, IgM, C3, C1q, kappa and lambda.

Case 4 H&E
Case 4 CD3
Case 4 CD20
Diagnosis & discussion [0]
Case 5
Female, 41 years. Transplant kidney biopsy, LRD 2 years ago - DNA'd review. Primary aetiology reflux nephropathy. Not been taking Ciclosporin for 1 month, on Azathioprine, restarted on Prednisolone, changed to MMF. Had 2 doses of Methylpred
Case 5 H&E
Case 5 silver
Case 5 C4d
Diagnosis & discussion [0]
Case 6
Female, 25 yo. Acute presentation with shortness of breath, decreased EF, heart failure. ? viral myocarditis. Low C3. Cr increased, eGFR 50. ? lupus nephritis ? post infectious GN
IH: Immunoglobulins negative. C3 provided.
H&E, PAS, silver, C3 IHC and 2 EM images provided.
C3 IH.jpg
Diagnosis & discussion [0]
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