August 2018 — Anatomic Pathology

The patient is a 78-year-old woman with a medical history significant for chronic kidney disease stage III, microscopic hematuria, and proteinuria. Investigations show a serum creatinine of 2 mg/dL and a 24-hour urine protein of 3,900 mg/24 hours.

Image 1: Mesangial expansion with PAS positive material.
Image 2: Immunofluorescence positivity (2+) for IgG in a smudgy mesangial staining pattern.
Image 3: Mesangial fibrillar deposits on EM.
Image 4: Extracellular and mesangial DNAJB9 deposition

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Kriselle Maris (Kriselle) Lao, M.D.
Former Resident, Renal Pathology
Mayo Clinic
Mariam (Priya) Alexander, M.D.
Consultant, Pathology
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
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