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Renal Biopsy: Diffuse Lupus Nephritis with Global Proliferative Active Lesions

This case study discusses a 19-year-old female with pneumonia, elevated creatinine, proteinuria, and low C3 and C4 levels. Renal biopsy reveals diffuse lupus nephritis with global proliferative active lesions.

jmchenry
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Renal Biopsy: Diffuse Lupus Nephritis with Global Proliferative Active Lesions

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  1. U06-19814 #489287010 • 19 y.o. female with pneumonia •  creatinine • proteinuria • very low C3, C4

  2. 19 year F transferred from High Level Hospital with Right Upper Lobe pneumonia, Anemia and ARF. • 10 days prior to this admission patient had productive cough with fever. • Symptoms worsen with time and with SOB, N and V was admitted to High Level Hospital. • Treated with Cefotaxime and Azithromycin for URL pneumonia. • Elevated serum Cr was presumed secondary to volume depletion and treated with IV Fluid (Cr decline from 220 to 140). • In the ER at UAH patient needed more Oxygen and finally got intubated and admitted to ICU. Blood Culture positive for S. Pneumoniae.

  3. Lab:Day of admission: October 17,2006 • C3: 0.23 • C4: <0.05 • Crea: 143 (stable around 130-140 on day 4) • Urea: 13 • WBC: 5.8 • Hgb: 80 • Phos: 1.52 • CK: 128 • Pro/Crea: 428 • Urine Microscopic: ? + RBC cast • IgG: 12.16 • IgA: 2.11 • IgM: .97 • dsDNA: 28Biopsy done in the ICU on 18-OCT-2006

  4. IF • IgG- Moderate to strong coarsely granular capillary loop staining and mesangial staining. Moderate granular peritubular staining. • IgA- Moderate coarsely granular capillary loop staining. • IgM- Moderate coarsely granular capillary loop staining. • C3- Moderate to strong coarsely granular capillary loop staining. • C1q- Moderate coarsely granular capillary loop staining. Moderate granular peritubular staining. • Kappa- Moderate coarsely granular capillary loop staining. Mild granular peritubular staining. • Lambda- Moderate coarsely granular capillary loop staining. Mild granular peritubular staining. • Fibrinogen- Mild interstitial staining. • Albumin-Negative.

  5. IgG

  6. IgG

  7. IgA

  8. IgM

  9. C3

  10. Clq

  11. Clq

  12. Kappa

  13. Kappa

  14. Lambda

  15. Lambda

  16. Fibrinogen

  17. DiagnosisRenal Biopsy: • Diffuse lupus nephritis with global proliferative active lesions • Class IV-G (A)

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