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U05-22801

U05-22801. Clinical History. (16894925):

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U05-22801

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  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

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