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Table 1 Main laboratory work-up, imaging and histology studies from 2004 to 2012

From: IgG4-related membranous glomerulonephritis and generalized lymphadenopathy without pancreatitis: a case report

Year Investigations Results
2004 Laboratory Work-up  
  Blood tests Serum creatinine: 3.51 mg/dL, eGFR: 24 ml/min/1.73 m2, low serum C3 and C4 levels, hypergammaglobulinemia (4590 mg/dL), hypoalbuminemia, negative ANA.
  Urine tests Proteinuria (13800 mg/l).
  Imaging studies
  Kidney ultrasound Diffuse kidney enlargement.
  Abdominal MRI Infracentimetric lombo-aortic lymphadenopathies and kidney enlargement.
  PET/CT Sub and super diaphragmatic hypermetabolic lymphadenopathies compatible with lymphoproliferative disorder associated with heterogeneous fixation in kidneys.
  Whole skeleton X-Ray No lesion.
  Histology studies
  Bone marrow biopsy Suspicion of myelodysplastic syndrome.
  Lymph node biopsy Reactive lymphoid hyperplasia.
  Renal biopsy MGN with IgG and C3d deposits associated with severe TIN and lymphoplasmocytic infiltrate.
2005 Histology studies
  Skin biopsy IgG and C3d deposits.
2008 Laboratory Work-up
  Blood tests Serum creatinine: 1.55 mg/dL, eGFR: 51 ml/min/1.73 m2, low serum C3 and C4 levels, hypergammaglobulinemia (3460 mg/dl), ANA (1/80) characterized as anti-dsDNA, thrombocytopenia.
  Urine tests Proteinuria (6081 g/l).
  Imaging studies
  Abdominal CT Iliac and aortic supra-centimetric lymphadenopathies.
  PET/CT Sub and super diaphragmatic hypermetabolic lymphadenopathies in progression compared to 2004.
  Whole skeleton X-Ray No lesion.
  Histology studies
  Bone marrow biopsy Reactive lymphoid hyperplasia of bone marrow.
  Lymph node biopsy Reactive lymphoid hyperplasia.
  Renal biopsy MGN with IgG and C3d deposits associated with chronic interstitial nephropathy (mononuclear infiltrate) without clear sign of tubular involvement.
2012 Laboratory Work-up
  Blood tests Serum creatinine: 1.6 mg/dL, eGFR: 48 ml/min/1.73 m2, low serum C3 and C4 levels, hypergammaglobulinemia (4250 mg/dL) with oligoclonal banding, ANA (1/640), Anti-dsDNA negative, IgG4 (2790 mg/dL), negative PLA2R antibodies test.
  Urine tests Proteinuria (444 mg/l).
  Imaging studies
  Thoraco-abdominal CT Sub and super diaphragmatic supracentimetric lymphadenopathies.
  PET/CT Sub and super diaphragmatic hypermetabolic lymphadenopathies in progression compared to 2008.
  Histology studies
  Lymph node biopsy IgG4-related lymphadenopathy (IgG4+/IgG+ cells > 40% and >10 IgG4+ plasma cells per HPF).
  1. Legend: ANA anti-nuclear antibodies, CT computed tomography, HPF high powered field, MGN membranous glomerulonephritis, MRI magnetic resonance imaging, PET/CT positron-emission tomography/computed tomography, PLA2R anti-phospholipase A2 receptor, TIN tubulo-interstitial nephropathy