1 / 16

204060810 U06-5523

204060810 U06-5523. DM with microhematuria. 44 yr married female,mother of two children, referred to the Renal clinic by family physician on january 27,2006 for investigation of protienuria with IDDM H/O Diabetes- Dx 1990-Gestational Age 29 Type 2- 7 years

tasha-chase
Download Presentation

204060810 U06-5523

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. 204060810 U06-5523 DM with microhematuria

  2. 44 yr married female,mother of two children, • referred to the Renal clinic by family physician on january 27,2006 for investigation of protienuria with IDDM • H/O Diabetes- Dx 1990-Gestational Age 29 • Type 2- 7 years • IDDM—4 years • Having laser treatment for retinopathy-partial blindness Left eye—2 years • Patient has no urinary symptoms • Depressed-recent death of her mother • Presenting features: • Hypertension-143/83 on Rx with ARB/HCTZ • Poorly controlled diabetes- HbAIc 9% • Urine analysis-protein,blood and red cell cast • Nephrotic range proteinuria (7gm/24hr) • Serum creatinine-166umol/L • GFR-31ml/min/1.73m2(MDRD) • C3/C4-normal • Quantitive Ig-IgG,IgA and IgM-normal • ANA-negative • U/S abdomen-normal kidneys U06-5523

  3. U06-5523 Other medical conditions: 1.hyperlipidaemia 2.hypothyroidism 3.anemia-normochromic,normocytic 4.Migraine headache Past Health: Diabetes diagnosed with pregnancy age 29-1990:Scr 57umol/L 1997-Scr 70umol/L- no proteinuria 2002-Scr 70umol/L-no proteinuria Renal diagnosis: 1. Chronic Kidney disease-Stage3 2. Nephrotic range of proteinuria + Hematuria ? Diabetic nephropathy with other parenchymal renal disease Plan: Investigate- renal biopsy

  4. IF • IgG-moderate background • IgA- minimal but definite granular mesangial in several segments of the non-sclerotic glomerulus. • IgM- trace mesangial,close to negative • C3- moderate to strong vascular and Bowman’s capsule near the vascular pole,with a few tiny mesangial granules • C1q-negative • Kappa-moderate basement membrane background with a few mesangial granules of doubtful significance • Lambda-same as kappa • Fibrin- moderate interstitial staining • Albumin- moderate to strong basement membrane background

  5. IgA

  6. C3

  7. Kappa

  8. Lambda

  9. Fibrin

  10. Albumin

  11. Comment: As well as the obvious diabetic nephropathy, the IF supports the presence of a small amount of mesangial IgA deposition,and the EM although indeterminate is at least consistent. The picture indicates a component of IgA nephropathy, but the advanced diabetic changes are by far the predominant process here.

  12. Diagnosis:Renal Biopsy:Advanced Diabetic Nephropathy. Superimposed focal proliferative Glomerulonephritis on the basis of IgA Nephropathy.

More Related