Fibrillary glomerulonephritis (FGN) is a rare disorder with poor kidney outcomes. Therapeutic strategies, particularly the use of immunosuppressive drugs, are challenging in this disorder. In a recently published article in AJKD, Javaugue et al present an interesting study looking at the long-term prognosis of FGN. Test your knowledge on this rare disorder by solving the anagrams below.

An anagram is a type of word play, a set of jumbled letters that can be rearranged to find a hidden answer (original word/phrase). For example, “main party here (1 word)” is an anagram for “hypernatremia.” Each anagram is followed by a hint meant to intellectually direct the reader towards the correct answer. The number of words that would form the final answer is indicated in parentheses next to the anagram.

1. INFORMATIONAL PAGER LIES (2 words)

The most common light microscopic finding in patients with FGN.

2. TO THYRONINE TREATMENT (4 words)

The size (ranges) of the infiltrating fibrils in patients with FGN.

3. I STITCH APE (2 words)

A 45-year-old homeless man presents to the emergency room with a 2 week history of 10 lbs weight gain, abdominal distention, and leg swelling. Labs reveal microscopic hematuria, 3 g proteinuia, a serum creatinine of 2 mg/dL, and an eGFR of 39 mL/min/1.73 m². Serologic workup is negative for HIV, syphilis, and hepatitis B. Complements are normal, with negative ANA and ANCAs. Serum immunoflorescence shows no M spike. Kidney biopsy shows membranous nephropathy with EM findings consistent with FGN. In addition to the above workup, this infection should be ruled out.

4. INFORMATIVE EAR PROBLEM (1 word)

Among the different light microscopic patterns of glomerular injury commonly seen in patients with FGN, this pattern is associated with the worst prognosis.

5. MEN REDO AUDITORIUMS (2 words)

In addition to dysproteinemias, carcinomas, and hepatitis C, these other general disorders should be ruled out in patients with FGN.

6. DO OIL GURU RELATIONSHIP COMMITMENT (2 words)

This other primary glomerular disease, in the same spectrum of FGN, is commonly associated with lymphoproliferative disorders, particularly chronic lymphocytic leukemia.

Here’s to a fruitful learning experience!

Questions prepared by Chinmay Patel, MD, Nephrology Fellow, Hofstra NSLIJ School of Medicine, and Kenar D. Jhaveri, MD, eAJKD Blog Editor

Answers can be found here.

To view the article abstract or full-text (subscription required), please visit AJKD.org.