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28-Year-Old Male with Acute Flank Pain and Elevated Creatinine: Renal Biopsy Findings

A 28-year-old healthy Caucasian male presented with bilateral flank pain that began gradually over the past 1-2 days. He experienced an increase in serum creatinine from 155 to 286 while receiving Solu-Medrol for "holiday induced headache" after consuming high doses of Advil. Despite IV fluid therapy, his creatinine continued to rise. Renal biopsy results indicated acute allergic interstitial nephritis with signs of tubular injury, but no definitive evidence of primary glomerular disease. Close monitoring and management are required for his renal condition.

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28-Year-Old Male with Acute Flank Pain and Elevated Creatinine: Renal Biopsy Findings

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  1. U06-24697 #32251-4521 • Healthy young male 28 Y came in with bilateral flank pain • Creat 155 went up to 286 • Received solumedrol 1 gm last night • Today’s creat in 272 • R/O GN

  2. 28/M- Caucasian • Came in with bilateral flank pain 1-2 days prior to admission. • Flank pain started gradually. Not radiating. No Dysuria, No Hematuria, No fever, No Chills, No sore throat and No Hx of Kidney stones. • Two-Three days prior to admission patient took 12-14 Advils (?400mg) for “Holiday Induced Headache” over 36-48 hours.

  3. PMH: • Anxiety: on Citalopram 100 mg/day (for about 4 years). • NO Hx of Kidney Disease, HTN, DM Allergy: NKDA

  4. Labs on admission: • Na, K, Cl, Anion Gap, Hgb, Platelet: NL • WBC:7K, Pmn 65%, Lymph 25%, Eosi 1% • Creat 155 (baseline Cr: 80-90 mmol/L), Urea 10 mmol/L • C-Reactive Protein: 30 mg/L • U/S of the Kidney: NL • U/A: pH: 5.50, SG: 1.010, Protein: +2, Hgb: +3, WBC 5-10

  5. Physical Examination: • Vitals: within Normal Limits • Lungs: CTA bilateral • Skin: No rash (except the flushing of the face) • Extremities: No pedal edema.

  6. Hospital Course: • Crea Increased to 280 despite of IVF therapy. • Patient was started on Steroid Pulse • Biopsy was scheduled. …..And Biopsy showed…

  7. IF • IgG-Negative. • IgA- Mild mesangial staining. • IgM- Trivial to mild mesangial staining. • C3- Mild to moderate mesangial staining. Moderate vascular staining. • C1q-Negative. • Kappa-Negative. • Lambda- Mild mesangial staining. • Fibrinogen- Moderate interstitial staining. • Albumin-Negative.

  8. IgA

  9. IgM

  10. C3

  11. C3

  12. Lambda

  13. Fibrinogen

  14. EM is pending

  15. DiagnosisRenal Biopsy: • Acute allergic interstitial nephritis with signs of tubular injury. • No definitive evidence of primary glomerular disease.

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