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U06- 23415. #813628120 SCr 184 Proteinuria 3+ Hematuria 3+ ? IgA ? RPGN. 45 year old male admitted to GIM in October 2006. Presented with purpuric rash over lower extremities 1 week hx of Indomethacin use prior to admission - PowerPoint PPT Presentation
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U06-23415
#813628120
• SCr 184
• Proteinuria 3+
• Hematuria 3+
• ? IgA
• ? RPGN
45 year old male admitted to GIM in October 2006• Presented with purpuric rash over lower extremities • 1 week hx of Indomethacin use prior to admission• Skin biopsy negative for IgA, ANCA, ANA neg,
complements normal, Hep B, Hep C, HIV neg• 1+ Hgb and 1+ protein on UA• Creatinine 70umol/L• Quant Ig slightly high IgA 4.23• Started on prednisone 50mg per day by GIM• No indication for biopsy, pt discharge with O/P followup
with nephrology
• seen by GIM and Rheumatology in followup in last week of November• Prednisone tapered to 20mg day• Peripheral edema• Creatinine increased from 70umol/L to 184 umol/L• UA 3+ protein, 3+ Hgb, 24 urine 3gm/day prot• ANA, ANCA negative• Pt reports dark colored urine• Urgent biopsy done Dec 7, 2006
IF
• IgG- Mild mesangial staining. • IgA- Mild to moderate mesangial staining. • IgM- Negative.• C3- Moderate mesangial staining. Moderate
vascular staining. • C1q- Negative.• Kappa- Negative.• Lambda- Mild mesangial staining. • Fibrinogen- Mild to moderate interstitial staining. • Albumin- Negative.
IgG
IgA
C3
C3
lambda
fibrin
EM
• Will be ready in the coming weeks
DiagnosisRenal Biopsy:• Biopsy of marginal adequacy showing
diffuse proliferative IgA nephropathy with possible superimposed acute allergic interstitial nephritis of unknown etiology.