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U06-7230 #676241610

U06-7230 #676241610. ↑ SG 300. Proteinuria, Vasculitis rash. Native (L) Kidney. 56 y man with PMH significant for tonsillectomy as a child, HT, arthritis and multiple allergies

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U06-7230 #676241610

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  1. U06-7230 #676241610 ↑ SG 300. Proteinuria, Vasculitis rash. Native (L) Kidney

  2. 56 y man with PMH significant for tonsillectomy as a child, HT, arthritis and multiple allergies • Presented with a 3-week history of flu-like illness with symptoms, including nausea, diarrhea, and generalized abdominal pain, preceded by what he thought was acute allergic dermatitis of both hands, consisting of erythematous, petechial lesions over his palms which continued to progress and involved his legs, feet, soles, and upper arms over the next few days. He has had similar rashes in the past • Available prior creatinine in Feb 2001 of 91mol/L and UA was negative • On admission: • creat 306mol/L • UA showed 3+ protein and 3+ blood • ANA +, DS DBA -, Hep B&C -, ANCA -, anti GBM-, C3&C4 normal, SPEP normal, cryo negative • RUS showed normal kidneys

  3. IF • IgG-negative ,strong background • IgA- one glomerulus negative,one other glomerulus with moderate granular mesangial staining • IgM- intermediate background,no glumeruli • C3- course granular staining in one structure which is probably a glomerulus • C1q-negative but possibly no glomeruli • Kappa-minimal to mild granular mesangial staining(same as IgA) • Lambda-two glomeruli,both negative • Fibrin- moderate to strong interstitial staining and tubular droplet • Albumin- moderate non-specific background

  4. IgA

  5. IgA

  6. Kappa

  7. Fibrin

  8. Diagnosis: Renal Biopsy: Focal proliferative and necrotizing glomerulosclerosis ,consistent with IgA nephropathy/Henoch-Schonlein purpura Necrotizing arteritis of small arteries.

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