1 / 4

U06-12318 #605635810

U06-12318 #605635810. 71 yo male,ARF (cr ~300) RBC casts ++ %g/day proteinuria PANCA +ve. U06-12318. 70 yo M admitted to CTU medicine (June 13) with confusion, ARF (sCr 285), anorexia, wt loss, weakness PMhx : Htn, dyslipidemia, COPD (80 py smoker), DHS R hip ?osteoporosis,

posy
Download Presentation

U06-12318 #605635810

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. U06-12318 #605635810 71 yo male,ARF (cr~300) RBC casts ++ %g/day proteinuria PANCA +ve

  2. U06-12318 70 yo M admitted to CTU medicine (June 13) with confusion, ARF (sCr 285), anorexia, wt loss, weakness PMhx: Htn, dyslipidemia, COPD (80 py smoker), DHS R hip ?osteoporosis, ?Etoh abuse. No documented renal disease. HPI 2 months ago: Visiting BC: picked up by police for driving erratically: admitted to hospital with delirium NYD, treated with risperidone: d/c after 1 week. sCr 170 (May, 2005: sCr=99). No documentation / discharge history available June 12: UAH ER: 1 mo history of anorexia, weakness, poor coordination, tremor, confusion. (Poor historian – separated from wife, few family) Meds: Risperidone, ASA, Coversyl 4mg OD. Physical Exam: 183/84, AFib 180  NSR 80 with fluid. Afebrile. Wasted: 47 kg. Disoriented x 3, agitated, resting tremor. No focal neuro signs. Clinically dry: dry MM, flat JVP, no edema. PPP. Lungs clear. No active joints, rashes, lymphadenopathy, bruits.

  3. Initial Investigations sCr 287, urea 40. U/A: 3+ protein, prot/Cr=469 mg/mmol, 26-50 RBC, occ WBC, occ hyaline casts. Urine C+S: no growth Na=153, K/TCO2/Cl N. sAlbumin=19, Ca=1.73, Po4=1.63, Mg N. LFTs, NH3, CK N. CBC: Hb 138 (MCV 95), Plt 159, WBC 6.1. Smear: no schistos, no hyperseg PMNs  Renal U/S: N sized kidneys, increased echogenicity. No masses/hydro. Course in Hospital -Admitted to CTU with confusion ?EtOH withdrawal, ARF, hypovolemia, AFib. -Supportive care: IV crystalloid, benzos -sCr: 284 (6/12)  316 (6/13)  315 (6/14) -Nephro consult (6/15): suspected pre-renal ARF with underlying intrarenal process. Too combative for biopsy: repeat urine studies and serology -SPEP/UPEP –ve for M-band, C3 0.73 (N 0.8-2.0), C4 N, anti-GBM negative - June 20: pANCA +ve, cANCA –ve, ANA+, dsDNA –ve Urine microscopy: ++RBC casts and heme-granular casts Minimal improvement in mental status CT head: non-acute ischemic lesions L frontal lobe and peri-ventricular white matter -June 21 (Wednesday): RENAL BIOPSY (after sedation)

  4. Diagnosis: Renal Biopsy: Arteritis with fibrinoid change and medium sized arteries with consequent tubular damage and membranoproliferative glomerulonephritis with occasional crescent formation.

More Related