U06-20274 #324676110 Creat 250 Nephritic urine ? Crescentic GN.

U06-20274

#324676110

• Creat 250

• Nephritic urine

• ? Crescentic GN

54-year old Caucasian male

• CC: Leg Edema, Skin Rash, Leg Pain and hands numbness.

• HPI: 8 Wks prior to admission he noticed leg edema and rash. Treated with Cephazolin and cephalexin for few days for cellulitis. No URI, No Fever, No gross hematuria, No Sore throat.

• PMH: Asthma (using combivent PRN)

Labs: (on admission)

• Hgb: 132• Cr 247 (Baseline Cr: 110)• U/A: SG of >1.030• Pro/Crea: 314.00• ALT, AST and Alk.Pho: NL• dsDNA: Neg,• RF(Sep2006): 22• ANA: NEG• p-ANCA and c-ANCA: NEG X 2• C3 and C4: 1.33 and .91

Kidney Biopsy on 25-OCT-06

?

IF• IgG- Negative.• IgA- Moderate irregular peripheral lobular finely granular

staining. • IgM- Negative.• C3- Moderate irregular peripheral lobular staining.

Moderate vascular staining. • C1q- Negative.• Kappa- Negative.• Lambda- Negative.• Fibrin- Mild interstitial staining. • Albumin- Negative.

IgA

IgA

IgA

IgA

C3

C3

Fibrin

EM

• Will be ready in the coming weeks.

DiagnosisRenal Biopsy:

• Focal proliferative GN with peripheral lobular granular staining for IgA and possible arteriolitis with necrotizing changes.

• Rule out Henoch-Schönlein purpura.

Comment: the IF pattern is unusual but has been described in Henoch-Schönlein purpura.

•Series of 10 paediatric cases•A/a focal and segmental hypercellularity with # monocytes•IgA deposits at periphery of lobules, not in mesangium•Early phase of disease ?

•3/6 subsequent biopsy was normal (with no IgA deposition) •3/6 subsequent biopsy with mesangial IgA