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U06- 20274. #324676110 Creat 250 Nephritic urine ? Crescentic GN. 54-year old Caucasian male. CC: Leg Edema, Skin Rash, Leg Pain and hands numbness. - PowerPoint PPT Presentation
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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
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.
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
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