Fig. 1

Timeline of clinical presentation, investigations and treatment. It is likely that the patient’s proteinuria initiated in 2013 and urine protein:creatinine ratio peaked at 662 mg/mmol prior to his first renal outpatient review in October, 2014. His second renal biopsy completed in February 2015 identified immunoglobulin A nephropathy (IgAN) and associated focal segmental glomerulosclerosis (FSGS). Bone marrow aspirate and trephine completed in March 2015 demonstrated low-grade B-cell lymphoma as the cause of his persistent abnormal serum electrophoresis pattern. Chemotherapy led to improvement in both serum electrophoresis pattern and urine protein excretion