Fibrillary glomerulonephritis with small fibrils in a patient with the antiphospholipid antibody syndrome successfully treated with immunosuppressive therapy.
BACKGROUND
Fibrillary glomerulonephritis is a rare cause of progressive renal dysfunction, often leading to the need for dialysis within a few years. The role of immunosuppressive treatment is still uncertain although this has been tried with variable success.


METHODS
A 56 year old woman with the antiphospholipid antibody syndrome (IgM anticardiolipin antibodies) was seen in the nephrology clinic with haematuria, proteinuria, and worsening renal function. A renal biopsy demonstrated a mesangial proliferative glomerulonephritis on light microscopy and smaller fibrils (10.6-13.8 nm in diameter) than is usual for fibrillary glomerulonephritis (typically 18-22 nm) on electron microscopy. Amyloidosis was excluded following detailed evaluation. On account of rapidly worsening renal failure she was started on cyclophosphamide and prednisolone which led to the partial recovery and stabilization of her renal function.


CONCLUSIONS
This case highlights the need for routine electron microscopy in native renal biopsies, where the differential diagnosis is wide and varied and the light and immunofluorescence microscopic findings may be non specific.
Javaid
Muhammad M
MM
Glan Clwyd Hospital, Bodelwyddan, Rhyl, UK. mmjaved68@hotmail.com
Denley
Helen
H
Tagboto
Senyo
S
D016736:Antiphospholipid Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage*; D016896:Treatment Outcome
D004338:Drug Combinations; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone