A Case of Fibrillary Glomerulonephritis

Fibrillary glomerulonephritis (FGN) is a very rare manifestation of glomerulonephritis characterized by the presence of deposits of randomly oriented microfibrils (10-30 nm size) in the glomeruli and visible on electron microscopy. Our patient is a 63-year-old African American male who presented with a past medical history of cirrhosis; he was initially suspected to have hepatorenal syndrome, but on kidney biopsy, and was diagnosed with FGN. Possible multiple myeloma was suspected due to its strong association with FGN and an elevated serum kappa-lambda ratio in the patient. This was confirmed by bone biopsy to be smoldering myeloma.