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Diagnostic Dilemma: Managing Renal Symptoms in a Patient with Multiple Conditions

A 34-year-old patient presents with flu-like symptoms, cough, and SOB, leading to a renal referral due to abnormal lab results. The case involves a history of HTN, PCOS, gout, and obesity, with family background of IgA nephropathy. The lab work indicates postinfectious glomerulonephritis with severe proliferative changes. How should the patient be managed given these complexities?

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Diagnostic Dilemma: Managing Renal Symptoms in a Patient with Multiple Conditions

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  1. U05-18498 #3846771104 34 years old from Vermilion referred with increasing Cr 730 baseline normal? Known to have: · HTN Dx 6 yrs ago on Coversyl and Atenolol· Polycystic ovarian syndrome, · Gout, · Obesity · Family Hx: Brother had IgA nephropathy S/P renal transplantC/O 2 weeks Hx of flue like symptoms, cough, sputum productionSOB, PND but no chest painNo skin rash or joint painOn exam: BP 150/90, O2 sat 94% on 5 L/min NRBM, LL oedemaLab: U/A: +3 protein, +3 Hb, WBC 1-5, RBC 26-50, Protein ~ 2 gm /day, Cr 730, K5.2, Co2 18, Cl 104,Na 139, HBV, HCV negative, ANA + speckled pattern, ANCA – negative, Anti-GBM negative, C3  0.27(0.8-2), C4  0.64 (0.8-0.36), ASO titre 1:680Throat swab + Strept pyogens

  2. IF • IgG- Mild mesangial staining • IgA- Mild mesangial staining with extension to peripheral capillary loops • IgM- Negative • C3- Trivial-mild capillary loop staining • C1q- Negative • Kappa- Negative • Lambda- Negative • Fibrin- Mild interstitial staining • Albumin- negative

  3. IgG

  4. IgA

  5. C3

  6. fibrin

  7. IgG

  8. IgG

  9. IgG

  10. IgG

  11. Diagnosis:Renal Biopsy:Postinfectious glomerulonephritis with severe proliferative changes

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