We do not know what the presenting symptoms were but the patient had a renal biopsy done on January 2009. The diagnosis is that of chronic glomerulonephritis with immune complex deposition. Some of the information we would like to have are not reported (light chain, kappa and lamda light chain) but we do know that 5/18 glomeruli are globally sclerosed. 13 had open capillaries and some of these have thickened Bowman's capsule.
The cause of the immune complex deposition disease is unclear from the data available. Possible causes include:
1. Post-infectious glomerulonephritis (including post-strep glomerulonephritis, hepatitis B, hepatitis C and HIV); all are ruled out by the tests indicated although ASLO titer is indeed elevated
2. Lupus nephritis is ruled out with the negative ANA and negative serologies
3. Cryoglobulinemia is still a possibility
4. IgA nephropathy is still a consideration
5. Membranous nephropathy is less likely with the included information
6. Idiopathic immune complex mediated glomerulonephritis is obviously the diagnosis of exclusion
The specific question that was asked was that of the timing of the transplant. The interesting observation is that the patient's renal function appears to be getting better from the February data set to the March data set. Since patients with post-infectious GN and inflammatory GN (such as lupus) can indeed improve after the acute flare, it would be prudent to continue to manage medically. Anti-hypertensive agents, Mimpara, Erythropoeitin and Venofen should be continued. Although the renal biopsy does show scaring with tubular atrophy and interstitial fibrosis, it is possible for the creatinine to settle in the 1.8 range.
Over time, however, the renal function may gradually progress to needing transplantation at a future date.
With respect to transplantation:
1. It would be important to identify any potential donor since we do have time to optimize this situation.
2. The patient should continue to try and optimize her body weight since steroid administration after the transplant can significantly aggravate the weight issue.
I would be happy to provide additional help depending upon the further characterization of the immune complex mediated GN.