Bibliographic record
Abstract
Introduction: Glomerular full-house immune complex deposition is a characteristic finding of lupus nephritis; however, in rare cases it can occur with other glomerulopathies. We present a case of non-lupus glomerulonephritis leading to full-house immunostaining on renal biopsy. Case Description: A 50-year-old gentleman presents with a one-month history of rash and a 20-kilogram weight loss over the past year. He denied infectious symptoms, arthralgias, or other constitutional symptoms. His examination was remarkable for palpable purpura on his legs. Initial investigations revealed an elevated creatinine 114 mmol/L, proteinuria (72mg/mmol) and hematuria. Further work-up showed low serum complements, but normal antinuclear antibodies and anti-double stranded DNA. CT imaging of the abdomen showed splenic infarcts and normal kidneys. He was started on empiric prednisone due to suspicion for an autoimmune process, but on further assessment, he was found to have poor dentition concerning for infectious endocarditis. Prednisone was stopped, and blood cultures returned positive for streptococcus mutans. He was hospitalized and started on ceftriaxone. A transesophageal echocardiogram showed vegetations on the mitral and aortic valves. A kidney biopsy was performed which showed moderate endocapillary hypercellularity with no significant tubular atrophy or interstitial fibrosis. Immunofluorescence was positive for IgG, IgA, IgM, C3, and C1q consistent with full-house immunostaining, suggesting a diagnosis of diffuse proliferative lupus nephritis. However, based on the lack of clinical manifestations and the negative lupus serology, it was suspected that this was a rare biopsy finding associated with infection-related glomerulonephritis (IRGN). He underwent CABG with atrial and mitral valve repair. Following completion of antibiotics his creatinine had normalized consistent with a resolved IRGN. Discussion: Glomerular full-house immunostaining typically occurs in lupus nephritis; however, it can occur in other diseases including IgA nephropathy, membranoproliferative glomerulonephritis, and IRGN. It is speculated that this deposition may occur in more severe forms of IRGN due to superantigen formation. This case emphasizes the importance of clinical presentation when interpreting renal biopsy findings as rarely patients with full-house immunostaining may have a diagnosis other than lupus nephritis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.007 | 0.009 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".