U06-7995#904681210

53 yr old woman with sinusitis,arthritispulmonary hemorrhage,microscopic hematuriaProteinuria 2.5g/day(+) pANCA,Cr 127ANA(+).Anti ds-DNA…,complements normal

53 year old woman with microscopic hematuria2+ proteinuria, HTN,Creatinine 111 (84 in July 05). pANCA positive.She has symptoms of sinusitis for 10 years, inflammation of multiple joints off and on.Feb 28 presented with flu like symptoms such as nasal discharge, cough and body ache treated with antibiotics. March 28 developed hemoptysis. CXR showed perihilar ground glass appearance possibly pulmonary hemorrhage.Bonchoscopy with BAL on April 10 showed hemorrhagic fluid.

U06-7995

• IgG-negative• IgA- negative• IgM- mild vascular staining• C3- trivial punctate mesangial staining,moderate

vascular staining• C1q-negative• Kappa-negative• Lambda-negative• Fibrin- mild to moderate intestinal staining• Albumin- focal hyaline droplet changes in

podocyte

IF

IgM

C3

Fibrin

Albumin

Diagnosis:Renal Biopsy:Chronic glomerulonephritis, consistent with a chronic phase of systemic vasculitis.A.no diagnostic immune complex deposition by immunofluorescence or ultrastructure.B.diffuse mesangioproliferative pattern in non-sclerotic glomeruli,with moderate disease activity and focal crescents.C. Moderate to severe parenchymal scarring