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U06- 16889

U06- 16889. #803963500 30 y.o. male with increased proteinuria, arthralgia and lower limb petechial rash. Hypertension ? Renal vasculitis ? Henoch-Schönlein purpura. 30 yo male with Nephrotic Syndrome. Acute onset lower extremity rash and edema Active urine sediment, hypertension, Cr 146

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U06- 16889

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  1. U06-16889 #803963500 • 30 y.o. male with increased proteinuria, arthralgia and lower limb petechial rash. • Hypertension • ? Renal vasculitis • ? Henoch-Schönlein purpura

  2. 30 yo male with Nephrotic Syndrome • Acute onset lower extremity rash and edema • Active urine sediment, hypertension, Cr 146 • 6g protein / 24 hrs • Urgent referral within 1 week • PHx: Strep throat, NEC as a neonate

  3. In Clinic • Spontaneous clinical improvement • Resolved edema, Cr 106, rash resolving • Still hypertensive and proteinuric 2g/24hrs • LE arthralgias persist, mild diarrhea • Serology all negative except: mildly depressed compliment levels, positive ASOT • No history of URTI

  4. Tx • Diuretics, ACEi, ARB • Follow up bloodwork at biweekly intervals shows increasing creatinine • Renal Biopsy performed

  5. IF • IgG-Negative. • IgA- Mild mesangial staining. • IgM-Negative. • C3- Moderate vascular staining. Mild mesangial staining. • C1q-Negative. • Kappa-Negative. • Lambda-Negative. • Fibrinogen- Strong staining of glomerular crescents. • Albumin-Negative.

  6. IgA

  7. C3

  8. Fibrin

  9. DiagnosisRenal Biopsy: • Crescentic diffuse proliferative glomerulonephritis with IgA deposition by IF suggesting Henoch-Schönlein purpura.

  10. Developed Pericarditis • Acute pleuritic chest pain • VQ scan negative • New rash • Referred to ID: ? Rheumatic Fever • Placed on penicillin prophylaxis

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