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U06- 22779

U06- 22779. #879263620 Pulmonary-Renal syndrome  creat P-ANCA +. History 79 yo Caucasian female PMHx: CKD stage 3 (GFR 40) borderline lipids Hypertension treated Hypothyroid disease Osteoporosis Recently diagnosed COPD/Emphysema – smoker until 1977. 20 py history

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U06- 22779

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  1. U06-22779 #879263620 • Pulmonary-Renal syndrome •  creat • P-ANCA +

  2. History • 79 yo Caucasian female • PMHx: • CKD stage 3 (GFR 40) • borderline lipids • Hypertension • treated Hypothyroid disease • Osteoporosis • Recently diagnosed COPD/Emphysema – smoker until 1977. 20 py history • Presented in Nov/06 with: • 6 wks systemic symptoms of weakness appetite, weight loss, • Persistent cough +/- hemoptysis and dyspnea unresponsive to inhalers and Abx course X 2/52 • Markedly Hypoxia (10L O2) on presentation with bilateral pulmonary infiltrated. • Marked Anemia (hgb – 65, normocytic with rouleux) • Pulmonary investigations: • Cultures negative for bacterial, myoplasma or CMV. • CT chest: emphysema. Widespread patchy ground glass opacity with consolidation with inter/intralobular septal thickening • +p-ANCA (1:320). ELISA pending • Creatinine = 367 (Nov 1, 06) → 456 (Nov 18, 06) → 350 with immunosuppression • Active U/A with 3+ hgb & 3+ ptn

  3. IF • IgG-Negative. • IgA-Negative. • IgM- Mild mesangial staining. • C3- Moderate mesangial staining. Moderate vascular staining. • C1q-Negative. • Kappa-Negative. • Lambda-Negative. • Fibrinogen- Moderate interstitial staining. • Albumin- Moderate hyaline droplet change in tubular cytoplasm.

  4. IgM

  5. C3

  6. C3

  7. Fibrinogen

  8. Albumin

  9. EM • Will be ready in the coming weeks

  10. DiagnosisRenal Biopsy: • Diffuse proliferative and necrotizing glomerulonephritis of pauci-immune character with extensive glomerulosclerosis, some of which may be due to pre-existing age-related vascular disease.

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