8
fever, diabetes, proteinuria (2.7 g), hematuria (20- 30rbc’s) – no rbc casts on urinanalysis. Labs normal including Cr, Complement, ANA, ANCA, MPO, PR3. Bad sinus infection in spring (3-4 weeks) with no PIGN signs. Renal bx: focal segmental crescentic and necrotizing gn (+/- 4 glomeruli with capillary necrosis; one cellular crescent), with focal mild mesangial proliferation. EM: IgG (2+), IgA (focal 1+), kappa+, lambda+, C3 trace, C1q neg - subepithelial/paramesangial deposits, No definite humps, No fibrils. No amyloid. Congo-red neg. Deposits not numerous. GBM variably thin and thick (range 137 – 537; 15% less than 200). DD: ANCA negative focal crescentic and necrotizing gn with IgG deposits Resolving PIGN (C3 trace). Plus: early diabetic nephropathy (thickening of GBM) superimposed on TBDM?? No association found between familial Mediterranean fever and TBMD

65 year old female with a h/o familial Mediterranean fever, diabetes, proteinuria (2.7 g), hematuria (20-30rbcs) no rbc casts on urinanalysis. Labs

Embed Size (px)

Citation preview

Page 1: 65 year old female with a h/o familial Mediterranean fever, diabetes, proteinuria (2.7 g), hematuria (20-30rbcs)  no rbc casts on urinanalysis. Labs

65 year old female with a h/o familial Mediterranean fever, diabetes, proteinuria (2.7 g), hematuria (20-30rbc’s) – no rbc casts on urinanalysis. Labs normal including Cr, Complement, ANA, ANCA, MPO, PR3. Bad sinus infection in spring (3-4 weeks) with no PIGN signs.

Renal bx: focal segmental crescentic and necrotizing gn (+/- 4 glomeruli with capillary necrosis; one cellular crescent), with focal mild mesangial proliferation. EM: IgG (2+), IgA (focal 1+), kappa+, lambda+, C3 trace, C1q neg - subepithelial/paramesangial deposits, No definite humps, No fibrils. No amyloid. Congo-red neg. Deposits not numerous.

GBM variably thin and thick (range 137 – 537; 15% less than 200). DD: ANCA negative focal crescentic and necrotizing gn with IgG depositsResolving PIGN (C3 trace).Plus: early diabetic nephropathy (thickening of GBM) superimposed on TBDM??No association found between familial Mediterranean fever and TBMD

Page 2: 65 year old female with a h/o familial Mediterranean fever, diabetes, proteinuria (2.7 g), hematuria (20-30rbcs)  no rbc casts on urinanalysis. Labs
Page 3: 65 year old female with a h/o familial Mediterranean fever, diabetes, proteinuria (2.7 g), hematuria (20-30rbcs)  no rbc casts on urinanalysis. Labs
Page 4: 65 year old female with a h/o familial Mediterranean fever, diabetes, proteinuria (2.7 g), hematuria (20-30rbcs)  no rbc casts on urinanalysis. Labs

IgG

Kappa

IgG

Lambda

Page 5: 65 year old female with a h/o familial Mediterranean fever, diabetes, proteinuria (2.7 g), hematuria (20-30rbcs)  no rbc casts on urinanalysis. Labs
Page 6: 65 year old female with a h/o familial Mediterranean fever, diabetes, proteinuria (2.7 g), hematuria (20-30rbcs)  no rbc casts on urinanalysis. Labs
Page 7: 65 year old female with a h/o familial Mediterranean fever, diabetes, proteinuria (2.7 g), hematuria (20-30rbcs)  no rbc casts on urinanalysis. Labs
Page 8: 65 year old female with a h/o familial Mediterranean fever, diabetes, proteinuria (2.7 g), hematuria (20-30rbcs)  no rbc casts on urinanalysis. Labs