U05-18498 #384677110434 years old from Vermilion referred with increasing Cr 730 baseline normal? Known to have: · HTN Dx 6 yrs ago on Coversyl and Atenolol· Polycystic ovarian syndrome, · Gout, · Obesity · Family Hx: Brother had IgA nephropathy S/P renal transplantC/O 2 weeks Hx of flue like symptoms, cough, sputum productionSOB, PND but no chest painNo skin rash or joint painOn exam: BP 150/90, O2 sat 94% on 5 L/min NRBM, LL oedemaLab: U/A: +3 protein, +3 Hb, WBC 1-5, RBC 26-50, Protein ~ 2 gm /day, Cr 730, K5.2, Co2 18, Cl 104,Na 139, HBV, HCV negative, ANA + speckled pattern, ANCA – negative, Anti-GBM negative, C3  0.27(0.8-2), C4  0.64 (0.8-0.36),ASO titre 1:680Throat swab + Strept pyogens

IF

• IgG- Mild mesangial staining• IgA- Mild mesangial staining with extension to

peripheral capillary loops• IgM- Negative• C3- Trivial-mild capillary loop staining• C1q- Negative• Kappa- Negative• Lambda- Negative • Fibrin- Mild interstitial staining• Albumin- negative

IgG

IgA

C3

fibrin

IgG

IgG

IgG

IgG

Diagnosis:Renal Biopsy:Postinfectious glomerulonephritis with severe proliferative changes