Fibrillary Glomerulonephritis

Introduction: AGE: 68 GENDER: Female ALLERGIES: None BP at Home: SBP 140-150s. PMH: HTN,OSA,COPD,CHpEF. Review of labs shows evidence of volume depletion in the past, hyaline casts. SH: tobacco use Current Meds: Losartan, Diltiazam, Lasix, Metolazon Worsening renal disease. Physical exam: Bilateral Pitting edema , Irregular rhythm 5.6 bun31 Cr 2.87 glucose113 GFR 18ml/min, CL 101 uric acid 4.4 Ca 8.4 phos 3.3, includes holding ARB therapy, renal ultrasound, UACR, Case Description: Next follow up visit: The patient's lab results show a worsening anemia and a need for an urgent kidney biopsy. Kidney ultrasound showed no hydronephrosis with R 9.5 cm, L 9 cm kidney. The cause of the condition remains unknown. Hospital course: The patient was prescribed IV steroid pulse for three days and received two units of PRBC. Urgent biopsy was held, and GI consultation was conducted. EGD/ colonoscopy showed only polyp which was removed with no malignancy, serology work up was negative. EGD/ colonoscopy showed was negative, serology work up was negative. Discussion: Fibrillary glomerulonephritis is a condition characterized by hematuria, proteinuria, kidney function impairment, hypertension, and monoclonal gammopathy. Diagnosis involves kidney biopsy, electrophoresis, immunofixation, serum free light chain levels, and other tests. Patients without known cancer should undergo age and risk appropriate cancer screening, while those with imamunotactoid glomerulopathy should be screened for monoclonal gammopathy. Management approach: Addressing underlying causes, immunosuppressive therapy, and supportive care.