Kidney Week

Abstract: PUB390

A Rare Case of Histiocytic Glomerulopathy

Session Information

• Publication Only

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Murari, Ujjwala, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States

Ujjwala Murari, MD

• Simhadri, Prathap, AdventHealth Centra Care, Altamonte Springs, Florida, United States

Prathap Simhadri, MD, MPH, FASN

• Amin, Md. Shahrier, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States

Md. Shahrier Amin, MBBS, PhD, FASN

• Parravani, Anthony J., West Virginia University Health Sciences Center, Morgantown, West Virginia, United States

Anthony J. Parravani, MD

Introduction

Histiocytic glomerulopathy is a rare kidney disorder characterized by presence of histiocytes within glomeruli leading to damage and dysfunction.

Case Description

38 year old white female with history of Hypertension and hypothyroidism referred to the CKD Clinic for worsening generalised swelling. Labs showed creatinine of 1.24mg/dl (baseline creatinine a month ago <1) with GFR 56, Electrolytes within normal limit, Hemoglobin 11.6g/dl , platelets 301 K . Urine studies showed nephrotic range proteinuria (10 grams), albumin 4g/dl which prompted to check serological work up include C3-68 and C4-21, rheumatoid factor is <15, ANA, dsDNA and hepatitis B/C were negative. Kappa and lambda chain ratio 1.5 with no M protein. In view of nephrotic proteinuria shared decision was taken to proceed with kidney biopsy.
Light microscopy: The glomeruli enlarged, marked endocapillary, mesangial hypercellularity. Many foamy histiocytes are noted within the capillary loops, confirmed by a CD68 immunostaining.
Immunofluorescence: There is granular capillary wall staining in the glomeruli for C3 (2+).
Electron Microscopy :The loops are distended by lipid laden cells and swollen endothelial cells. No crystals are seen
Since the biopsy showed histiocytic glomerulopathy further work up ordered like EBV, Parvovirus , Cytomegalovirus and EBV Ig M and Ig G antibody positive and PCR negative. Ferritin levels were 155, Fibrin 564.Plan is to start on steroids .

Discussion

Histiocytic glomerulopathy is multifactorial disorder with complex interplay of genetics, immunological and environmental factors contributing to its pathogenesis. Further research is needed to elucidate the precise mechanisms underlying the development and progression of this condition.In the above case the possible factor could be EBV (Epstein bar virus) stimulating an immune response leading to accumulation of histiocytes in the kidney