u05-22801. clinical history (16894925): generalized decline in health since feburary 2005 including:...
TRANSCRIPT
U05-22801
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/C4Nov 28 low C3- 0.42, C4- 0.17, Nov
15 Norm ANANov 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
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
IgG
IgA
IgM
C3
C3
Kappa
Fibrin
EM Pending……
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