1 / 28

66 F

66 F. PMH: HTN, Gout, DVT (Feb/06 and ? Sep/06) PMH: Heterozygous for Prothrombin mutation. FOCAL PROLIFERATIVE IMMUNE COMPLEX GN (toward chronic GN)  Biopsy done in 2004, pANCA positive. On PD then switch to HD on May 2006 Medications on admission: Fragmin, Replavite, Crestor

elam
Download Presentation

66 F

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 66 F • PMH: HTN, Gout, DVT (Feb/06 and ? Sep/06) • PMH: Heterozygous for Prothrombin mutation. • FOCAL PROLIFERATIVE IMMUNE COMPLEX GN (toward chronic GN)  Biopsy done in 2004, pANCA positive. • On PD then switch to HD on May 2006 • Medications on admission: Fragmin, Replavite, Crestor • Living Related Kidney Transplant (14-Nov-06)

  2. U04-22639 #897870100 • Native kidney • 64 y.o. female with Cr 188, 3+ hemoglobinuria, about 300 g proteinuria • Vasculitic work-up negative

  3. IF • IgG- Minimal wipsy mesangial staining, looks just discernibly above background. • IgA-Negative. • IgM- Minimal to mild fine granular mesangial staining. • C3- Mild vascular and vascular pole staining. • C1q-Negative. • Kappa- Trace level fine granular mesangial staining. • Lambda-Negative. • Fibrinogen- Mild to moderate interstitial staining. • Albumin- Moderate background with mild hyaline droplet change in tubular cytoplasm.

  4. IgG

  5. IgM

  6. C3

  7. Kappa

  8. Fibrin

  9. Albumin

  10. DiagnosisRenal Biopsy: • Focal proliferative immune complex glomerulonephritis progressing toward chronic glomerulonephritis.

  11. Ms. CH 66 F • PMH: HTN, Gout, DVT (Feb/06 and ? Sep/06) • PMH: Heterozygous for Prothrombin mutation. • FOCAL PROLIFERATIVE IMMUNE COMPLEX GN (toward chronic GN)  Biopsy done in 2004, pANCA positive. • On PD then switch to HD on May 2006 • Medications on admission: Fragmin, Replavite, Crestor • Living Related Kidney Transplant (14-Nov-06)

  12. U06-21732 #897870100 • LRD Tx

  13. DiagnosisRenal Biopsy (at time of implantation): • No specific diagnostic findings • Minimal arteriosclerotic vascular changes

  14. Hospital Course: • Excellent/ immediate post-op kidney function. • Hypotension and low Hgb: 3 units PRBC • Immunosuppression: • Belatacept (Belatacept benefit study) • Prednisone • MMF • Meds on discharge: Crestor, Valganciclovir, Replavite, Losec, MMF, Prednisone, Benefit008 study drug, phosphate, senokot, Fragmin. • Started on coumadin Nov 28th.

  15. Creatinine started to rise Nov 28th. • Developed macroscopic hematuria Dec 2nd.

  16. Follow up Visits: Other work up: • LD, T. Bili, ALT: NL • P-ANCA + • PBS: NL • Hapto: Pending • Peak creatinine 204 µmol/L Dec 8th • Hem/Onc Consult on Dec 13th

  17. Kidney Biopsies ?

  18. U06-23272 #897870100 • LRD Tx 14/11/06 • Creat 70  140 over several days

  19. IF • C4d-Negative.

  20. EM • Will follow in the coming weeks

  21. DiagnosisRenal Biopsy (1 week post-Tx): • Tubular hemorrhage and injury • Further report to follow • Banff score: G0 I1 T1 V0 AH0 • Biopsy of marginal adequacy

  22. U06-23805 #897870100 • LRD kid Tx 1 month ago • Creat 70  200 • Previous biopsy 1 week ago • Why blood in tubules ? With proteinuria

  23. IF • C4d-Negative.

  24. EM • Will follow in the coming weeks

  25. DiagnosisRenal Biopsy (1 month post-transplantation) • Thrombotic microangiopathy of uncertain etiology • Banff score: G0 I1 T1 V0 AH0 • Further report to follow • Tubular hemorrhage, injury, and regenerative features

More Related