U05-11480
#009N3585833
• Recurrent edema with most recent episode proteinuria with creat > 300
DOB: 26 Jan 1981
• 25 yo Caucasian female. • Medical History:
1. Normal renal function with Baseline Cr of 56 and bland U/A 2001
2. Possible Pyelonephritis 6 years ago – hospital admission and antibiotic
3. Obese – BMI 35 kg/m2
4. Smoker5. Bronchitis X 16. Depression7. Remote Cocaine/crack. No IVDU. HBV/HCV/HIV
negative
Acute Renal Failure June 2005. • Two day history bilateral flank pain and urinary hesitancy. • Initial renal work-up: Cr 182 and Urine +3 protein, trace hgb, no
leuks, 10 WBC. Culture negative but did receive IV Cefotaxime 2 hour before urine collection.
• No ptn/cr urine at presentation but PAD 3 ptn/Cr 27.45 mg/mol. • Immunologic investigations in June unremarkable: neg-ANA, neg-ds-DNA and neg-ANCA (weakly), normal C3, C4. Normal kidney ultrasound.
• HCV/HCV/HIV negative• Subsequent investigations: 08/2005 Cr 79 and U/A normal. 09/2005
U/A 2+ ptn, 4+ blood, 1+leuks.
Renal Biopsy post-presentation day 5 (June 10 2005)
• Referred Sept 2006 for subjective bilateral flank pain daily and pedal edema. Creatinine 60. Urine neg for ptn/hgb. No ptn/cr. Normal liver enzymes and function, and normal TSH.
• History unremarkable for pulmonary symptoms, those suggestive of chronic suppurative process, connective tissue disease or an auto-immune condition except parathesias and pre-syncopal episodes (non-witnessed). No objective findings confirming deficit in power, tone or DTRs. Neurology to see in October
IF
• IgG- Negative.• IgA- Trivial to mild mesangial staining. • IgM- Moderate mesangial staining. • C3- Trivial to mild mesangial staining. • C1q- Negative.• Kappa- Negative.• Lambda- Negative.• Fibrin- Mild interstitial staining.• Albumin- Negative.
IgA
IgM
C3
Fibrin
DiagnosisRenal Biopsy:
• Focal glomerular sclerosis with relatively mild changes by light microscopy.
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