1 / 12

U05-22801

U05-22801. Clinical History. (16894925):

yachi
Download Presentation

U05-22801

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. U05-22801

  2. Clinical History • (16894925): • Generalized decline in health since Feburary 2005 including: Wt loss/recurrent ‘Pneumonia’/ arthralgia and joint pain. New-A fib. Anemia (80s) and Alb (20). Cr ~140  190 over/ 5 mo. For Xfer to Nephro Nov 27/05 ‘coded’ on route with ?sz vs pulse loss. Intubated. Inotropes ++, PRISMA Nov 29/05 and now anuric • PmHx: DMN/ HTN/Bicuspid Ao/repaired AAA • Meds: Abx -? Type. No known NSAIDs or toxins • pANCA + x 2 Nov 15 - Norm C3/C4Nov 28 low C3- 0.42, C4- 0.17, Nov 15 Norm ANANov 28 ANA +, • Negative HBV/HCV, Anti-GBM, SPEP/Urine Bence Jones. ASOT. Intermittent Cryoglobumins and +DAT • Urine: +ptn/+3hgb - +hemegran +WBC/RBC casts • Renal Bx: LM- No significant glomerular changes beyond DMN . +RBC casts. ++Toxic vacoulization of tubular cells, and ?crystal • TEE – possible vegetation. B/C 4/4 Staph Aureus. CT head – bilateral hypodensities - ?mets/emboli • R knee aspirate – 8000 WBC – no growth

  3. IMMUNOFLUORESCENCE • IgG – Mild mesangial staining • IgA - Mild to moderate mesangial staining • IgM – Trivial to mild mesangial staining • C3 - Moderate vascular staining, moderate mesangial staining • C1q - Negative • Kappa - Mild to moderate mesangial staining • Lambda - Negative • Fibrinogen Mild mesangial staining • Albumin - Negative

  4. IgG

  5. IgA

  6. IgM

  7. C3

  8. C3

  9. Kappa

  10. Fibrin

  11. EM Pending……

  12. Diagnosis • IgA Nephropathy with focal proliferative glomerulonephritis and unexplained striking vacuolization of tubules with white cell casts and unusual crystalline material seen in glomerular capillaries. • Rule out some kind of toxic exposure

More Related