28058320 U06-110 54y/o man with recent dx of HI +DM. creatinine increasing rapidly 140-200 in 6...
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28058320U06-110
54y/o man with recent dx of HI +DM.creatinine increasing rapidly 140-200 in 6 months.ACR low at 5.3, 2+ hematuria x 2-3 years with negative cystoscopyRUS (normal) 244 unit calcium/oxalate normalNegative serologies, normal C3/C4HG BM negative. ANCA negative
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» BB 54y male referred for increasing creatinine Dec 2005
• HT diagnosed 2005, SBP in 120-140s, recently increasing to 160s
• DM diagnosed 1/04 with HBA1c of 12.5%, glucose control improved fast, 2/05 HBA1c 6.4%; 11/05 HBA1c 5.8%
• Microscopic hematuria x few years, renal US normal, cystoscopy negative May 2005Orfila et al
• Other med hx: remote stones, hypothyroid x 1 yr, no DM complications
• Meds: glipzide 80 bid, Metformin 500 bid, HCTZ 25 mg, Diovan 160 mg q day, Synthroid 0.75 q day, Norvasc 5 q day, and aspirin 81 mg daily.
• Serologies negative, 24h U Ca/oxalate normal, U eos neg, ACE normal, imaging normal – renal, retroperitoneaum, hemolysis w/up neg
date 1/04 2/05 7/05 11/05 12/8 12/19 1/3 1/6 1/11 2/6 2/23
creat 93 132 125 160 201 210 232 225 285 180 239
ACR 7.3 1.1 8.1 5.34 9.55
heme 1+ trace 2+
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• IgG- moderate linear GBM staining , common finding in diabetes
• IgA- moderate to strong mesangial staining• IgM- negative• C3- moderate mesangial staining,moderate
vascular staining• C1q- negative• Kappa- negative• Lambda- negative• Fibrin- moderate interstitial staining• Albumin- moderate linear GBM and TBM
staining , common finding in diabetes
IF
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IgG
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IgA
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C3
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C3
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Fibrin
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Albumin
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Diagnosis:Renal Biopsy:Diabetic glomerulopathy with superimposed IgA nephropathy