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U06- 23362. #944696920 ATN 1 year ago with recovery but now proteinuria with DM ?other diagnoses. 49y Aboriginal male with DM dxd in 1989 and HT dxd in 2003 Several admissions to ER with high creatinines which then resolved, ? From volume depletion/ACE inhibition, elevated CKs - PowerPoint PPT Presentation
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U06-23362
#944696920
• ATN 1 year ago with recovery but now proteinuria with DM
• ?other diagnoses
• 49y Aboriginal male with DM dxd in 1989 and HT dxd in 2003• Several admissions to ER with high creatinines which then resolved,
? From volume depletion/ACE inhibition, elevated CKs• Creatinine oscillating• High grade proteinuria, 3+ since at least 2004, PCR of 707 on July
2006.• HbA1c 10.1 in 2004, 7.2 in Nov 2006• UA –tr- 1+ blood, 3+ protein, some dysmorphic rbc, no rbc casts,
some granular casts• C3, C4 normal, ANA, ANCA, anti GBM, SPEP, Hep B, Hep C
negative• Albumin 27, Cholesterol 7.14 → CK of 900 on lipitor!• Renal US – normal kidneys• BP shot up in October, requiring 4-6 meds for control, c/o puffy face
and periodic pedal edema• MRA – no renal artery stenosis
Creatinine
Urine PCR
ER, ? dehydration
ER, ? dehydration
Renal clinic
BP 121/72
BP 146/87
BP 194/107
BP 116/86
BP 117/80
IF• IgG- Mild linear GBM staining, a common finding in diabetes.• IgA- Mild to moderate mesangial staining. • IgM- Mild mesangial staining. Mild vascular staining. • C3- Mild to moderate mesangial staining. Moderate vascular
staining. • C1q- Moderate mesangial staining. Moderate vascular staining. • Kappa and Lambda- Negative.• Fibrinogen- Mild interstitial staining. • Albumin- Mild to moderate linear GBM and TBM staining, a
common finding in diabetes. Moderate hyaline droplet change in tubular cytoplasm.
IgG
IgA
IgM
IgM
C3
C3
C1q
C1q
fibrinogen
albumin
albumin
albumin
EM
• Will be ready in the coming weeks
DiagnosisRenal Biopsy:• Diffuse diabetic glomerulosclerosis with
superimposed focal proliferative IgA nephropathy with occasional crescent formation.
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