00:01 Okay, let's start with a clinical case. We have a 63-year-old gentleman. 00:05 He's noted to have microscopic hematuria and proteinuria on his recent laboratory data. 00:11 He has a history of hepatitis C, genotype 1a, and he's planned by his hepatologist for direct-acting antiviral therapy. 00:21 On physical exam, his blood pressure is elevated to 150/88 mmHg, he has trace, maybe 1+ lower extremity edema, otherwise, his exam his fairly unremarkable. 00:32 On laboratory data, his serum creatinine is slightly elevated at 1.3 mg/dL and his urine analysis is positive for blood on the dipstick. 00:41 When you look at the urine sediment underneath the microscope, it shows dysmorphic red blood cells, so those funny-shaped red blood cells that we were talking about. 00:49 A few red blood cell casts and that spot urinary albumin-to-creatinine ratio is high at 1.2 g, meaning that it estimates about 1.2 g in a 24-hour period of time. 01:02 When the blood studies, the serological studies, show a low complement C3 and C4. 01:09 So, the question is, what is the most likely etiology of this man's renal presentation. 01:14 Let's take a look through our history and our exam, and see if we can come to some clinical clues here. 01:20 So, I think importantly, our gentleman has microscopic hematuria and proteinuria in the setting of hepatitis C. 01:28 That's important because there are only certain diseases that are going to manifest with certain viral infections. 01:34 So, something like hepatitis C-associated MPGN might be coming to mind. 01:40 His exam definitely manifest with some of the features of nephritic syndrome that we talked about. 01:45 He has an elevated blood pressure, he's got some edema, proteinuria, and hematuria. 01:50 His laboratory data is also interesting. 01:53 We see an increase in his creatinine, we also see these dysmorphic red blood cells, and red blood cell cast. 02:00 That's a giveaway that there's something going on. 02:02 This is what we call an active sediment. 02:04 So, this is hematuria of glomerular origin and he also has subnephrotic range proteinuria. 02:11 The clincher in this case is that he has a low C3 and C4, so complement is being activated through that classical pathway of activation. 02:20 Taken together with hepatitis C, this really is membranoproliferative glomerulonephritis in association with hepatitis C. 02:29 We'll go over that so you'll understand that process.
The lecture Renal Case: 63-year-old Man with Microscopic Hematuria by Amy Sussman, MD is from the course Nephritic Syndrome.
Which of the following is associated with membranoproliferative glomerulonephritis (MPGN)?
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