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U06- 24697

U06- 24697. #32251-4521 Healthy young male 28 Y came in with bilateral flank pain Creat 155 went up to 286 Received solumedrol 1 gm last night Today’s creat in 272 R/O GN. 28/M- Caucasian. Came in with bilateral flank pain 1-2 days prior to admission.

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U06- 24697

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  1. U06-24697 #32251-4521 • Healthy young male 28 Y came in with bilateral flank pain • Creat 155 went up to 286 • Received solumedrol 1 gm last night • Today’s creat in 272 • R/O GN

  2. 28/M- Caucasian • Came in with bilateral flank pain 1-2 days prior to admission. • Flank pain started gradually. Not radiating. No Dysuria, No Hematuria, No fever, No Chills, No sore throat and No Hx of Kidney stones. • Two-Three days prior to admission patient took 12-14 Advils (?400mg) for “Holiday Induced Headache” over 36-48 hours.

  3. PMH: • Anxiety: on Citalopram 100 mg/day (for about 4 years). • NO Hx of Kidney Disease, HTN, DM Allergy: NKDA

  4. Labs on admission: • Na, K, Cl, Anion Gap, Hgb, Platelet: NL • WBC:7K, Pmn 65%, Lymph 25%, Eosi 1% • Creat 155 (baseline Cr: 80-90 mmol/L), Urea 10 mmol/L • C-Reactive Protein: 30 mg/L • U/S of the Kidney: NL • U/A: pH: 5.50, SG: 1.010, Protein: +2, Hgb: +3, WBC 5-10

  5. Physical Examination: • Vitals: within Normal Limits • Lungs: CTA bilateral • Skin: No rash (except the flushing of the face) • Extremities: No pedal edema.

  6. Hospital Course: • Crea Increased to 280 despite of IVF therapy. • Patient was started on Steroid Pulse • Biopsy was scheduled. …..And Biopsy showed…

  7. IF • IgG-Negative. • IgA- Mild mesangial staining. • IgM- Trivial to mild mesangial staining. • C3- Mild to moderate mesangial staining. Moderate vascular staining. • C1q-Negative. • Kappa-Negative. • Lambda- Mild mesangial staining. • Fibrinogen- Moderate interstitial staining. • Albumin-Negative.

  8. IgA

  9. IgM

  10. C3

  11. C3

  12. Lambda

  13. Fibrinogen

  14. EM is pending

  15. DiagnosisRenal Biopsy: • Acute allergic interstitial nephritis with signs of tubular injury. • No definitive evidence of primary glomerular disease.

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