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28058320 U06-110

28058320 U06-110. 54y/o man with recent dx of HI +DM. creatinine increasing rapidly 140-200 in 6 months. ACR low at 5.3, 2+ hematuria x 2-3 years with negative cystoscopy RUS (normal) 244 unit calcium/oxalate normal Negative serologies, normal C3/C4 HG BM negative. ANCA negative.

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28058320 U06-110

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  1. 28058320 U06-110 54y/o man with recent dx of HI +DM. creatinine increasing rapidly 140-200 in 6 months. ACR low at 5.3, 2+ hematuria x 2-3 years with negative cystoscopy RUS (normal) 244 unit calcium/oxalate normal Negative serologies, normal C3/C4 HG BM negative. ANCA negative

  2. BB 54y male referred for increasing creatinine Dec 2005 • HT diagnosed 2005, SBP in 120-140s, recently increasing to 160s • DM diagnosed 1/04 with HBA1c of 12.5%, glucose control improved fast, 2/05 HBA1c 6.4%; 11/05 HBA1c 5.8% • Microscopic hematuria x few years, renal US normal, cystoscopy negative May 2005Orfila et al • Other med hx: remote stones, hypothyroid x 1 yr, no DM complications • Meds: glipzide 80 bid, Metformin 500 bid, HCTZ 25 mg, Diovan 160 mg q day, Synthroid 0.75 q day, Norvasc 5 q day, and aspirin 81 mg daily. • Serologies negative, 24h U Ca/oxalate normal, U eos neg, ACE normal, imaging normal – renal, retroperitoneaum, hemolysis w/up neg

  3. IF • IgG- moderate linear GBM staining , common finding in diabetes • IgA- moderate to strong mesangial staining • IgM- negative • C3- moderate mesangial staining,moderate vascular staining • C1q- negative • Kappa- negative • Lambda- negative • Fibrin- moderate interstitial staining • Albumin- moderate linear GBM and TBM staining , common finding in diabetes

  4. IgG

  5. IgA

  6. C3

  7. C3

  8. Fibrin

  9. Albumin

  10. Diagnosis:Renal Biopsy:Diabetic glomerulopathy with superimposed IgA nephropathy

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