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U06- 23415

U06- 23415. #813628120 SCr 184 Proteinuria 3+ Hematuria 3+ ? IgA ? RPGN. 45 year old male admitted to GIM in October 2006. Presented with purpuric rash over lower extremities 1 week hx of Indomethacin use prior to admission

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U06- 23415

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  1. U06-23415 #813628120 • SCr 184 • Proteinuria 3+ • Hematuria 3+ • ? IgA • ? RPGN

  2. 45 year old male admitted to GIM in October 2006 • Presented with purpuric rash over lower extremities • 1 week hx of Indomethacin use prior to admission • Skin biopsy negative for IgA, ANCA, ANA neg, complements normal, Hep B, Hep C, HIV neg • 1+ Hgb and 1+ protein on UA • Creatinine 70umol/L • Quant Ig slightly high IgA 4.23 • Started on prednisone 50mg per day by GIM • No indication for biopsy, pt discharge with O/P followup with nephrology

  3. seen by GIM and Rheumatology in followup • in last week of November • Prednisone tapered to 20mg day • Peripheral edema • Creatinine increased from 70umol/L to 184 umol/L • UA 3+ protein, 3+ Hgb, 24 urine 3gm/day prot • ANA, ANCA negative • Pt reports dark colored urine • Urgent biopsy done Dec 7, 2006

  4. IF • IgG- Mild mesangial staining. • IgA- Mild to moderate mesangial staining. • IgM-Negative. • C3- Moderate mesangial staining. Moderate vascular staining. • C1q-Negative. • Kappa-Negative. • Lambda- Mild mesangial staining. • Fibrinogen- Mild to moderate interstitial staining. • Albumin-Negative.

  5. IgG

  6. IgA

  7. C3

  8. C3

  9. lambda

  10. fibrin

  11. EM • Will be ready in the coming weeks

  12. DiagnosisRenal Biopsy: • Biopsy of marginal adequacy showing diffuse proliferative IgA nephropathy with possible superimposed acute allergic interstitial nephritis of unknown etiology.

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