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c/c-

Rise in serum creatinine incidentally detected onroutine checkup

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Past history-

No history of diabetesmellitus,hypertension,asthma,TB

H/O DESI MEDICATION INTAKE FOR WEIGHTREDUCTION PRESENT(6 MONTHS)

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Family history-

Father died of intracranial hemorrhage 8yrs back.hehad a h/o hypertension

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General examination-

Patient is obese

BMI-31.10

BP-130/90mm right arm supine position PR-76/min

Afebrile

RR-16/min

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Mild pallor

No

jaundice

Clubbing Cyanosis

Pedal edema = +nt

No skin changes

LAP

JVP not raised

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CNS-

Higher motor functions within normal limits

Reflexes all present

CVS-

S1 S2 normal

No S3 No murmurs

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Urine exam-

Proteinuria-+2

80-100 RBC/hpf

Pus cells-nil

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Hemoglobin 9.2

TLC 4.79

UREA 190

CREATININE 7.46

VIRAL MARKERS NONREACTIVE

24HR URINE PROTEINS 7.7GMS/24HOURS

P-ANCA +VE

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TLC 4.46 4.4 10.6 13.6

Hb 6.7 6.1 9.2 10.7

Platelets 135 169 46 70

Urea 201 138 127 167

Creatinine 8.25 5.7 5.4 7.00

Na/k 134/5.39 136/5.38 140/4.9 138/4.8

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Urine routine-

Albumin-2+

RBCs-60-70

Pus cells-35-40

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Ecg-within normal limits

Chest xray-within normal limits

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Ultrasound abdomen

Right kidney-9.6cms

Left kidney-9.2cms

CMD maintained Fatty liver

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Provisional diagnosis-

Rapidly progressive glomerulonephritis

1.Anti GBM disease

2.Double positive disease

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RENAL BIOPSY-

Showed 30 glomeruli,22 out of which showedpresence of crescents(9 cellular,7 fibrocellular,6fibrous in nature)

Few showed partial sclerosis and,partial to totalsclerosis

Tubulesshowed degenerative changes with tubularatrophy and compensatory dilitation of the rest

Blood vessels showed thickenedvessel wall

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Immunoflorescence-

Linear deposits of IgGand weak complement(C3)along glomerular capillary basement membranenoted.

Fibrinogen positive in few of the crescents.

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