U74-1807
#EGH 74-4670
• No clinical information
68 YOM
• Was sent from Norwood for evaluation of Acute Renal Failure and worsening extremities edema.
• His Baseline Cr was 300’s (Aug06). the day of admission his Cr was 650’s
• Was sent to UofA hospital for evaluation of Acute on Chronic Renal Failure.
PMH:
• SLE: Not Biopsy proven, ds-DNA neg• MPGN: Biopsy done in 1974 • CAD: S/P CABG few years ago (5 vessels)• Cirrhosis: based on U/S. not biopsy. etiology NASH vs.
Cryptogenic Cirrhosis• Seizure• Gout• HTN• Dyslipidemia• 3rd Degree Heart Block DDDR pacemaker• A.Fib ex- warfarin therapy (Warfarin was D/C on Aug)
Labs: (day of admission)
135 97 41 INR: 1.4
5.8 AG 16
4.6 22 630 ALT&AST:45 & 46
T. Bili: 20
UNa 63
93 Urine S/G: 1.013
8.8 252
.28
Hospital Course:
• With Diagnosis of Acute on Chronic (pre-renal) patient was started on Lasix 40 Q day and Spironolactone 100 mg QD then Lasix 80 BID.
• U/O: 1000 cc/day (average)
• R IJ was placed and HD started.
Light microscopy (slides are not available)
2 glomeruli showing:• Moderately severe membrano-proliferative
changes:– Mesangial cell hyperplasia in axial regions of tufts– Swelling of podocytes and endothelial cells– Patchy thickening of glomerular basement membranes– Capillary lumina are narrowed
• Hypertrophy and hyperplasia of parietal epithelial cells
• Peri-glomerular fibrosis
IF
• IgG- Moderate to marked granular deposits.
• IgA- Trace amounts.
• IgM- Trace amounts.
• C- Moderate to marked granular deposits.
Original diagnosis (1974)Renal Biopsy:
• Membrano-proliferative glomerulonephritis,– Process is active– Most consistent with a diagnosis of immune-
complex induced GN
Upon review of EM pictures
• EM supports a diagnosis of post-infectious or membranous GN.
• Presence of numerous subepithelial deposits, somewhat more irregularly spaced than would be usual for membranous.
