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.