U06-12318 #605635810. 71 yo male,ARF (cr ~300) RBC casts ++ %g/day proteinuria PANCA +ve. U06-12318. 70 yo M admitted to CTU medicine (June 13) with confusion, ARF (sCr 285), anorexia, wt loss, weakness PMhx : Htn, dyslipidemia, COPD (80 py smoker), DHS R hip ?osteoporosis,
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71 yo male,ARF (cr~300)
RBC casts ++
70 yo M admitted to CTU medicine (June 13) with confusion,
ARF (sCr 285), anorexia, wt loss, weakness
Htn, dyslipidemia, COPD (80 py smoker), DHS R hip ?osteoporosis,
?Etoh abuse. No documented renal disease.
2 months ago: Visiting BC: picked up by police for driving erratically:
admitted to hospital with delirium NYD, treated with risperidone:
d/c after 1 week. sCr 170 (May, 2005: sCr=99).
No documentation / discharge history available
June 12: UAH ER: 1 mo history of anorexia, weakness,
poor coordination, tremor, confusion. (Poor historian – separated from wife, few family)
Meds: Risperidone, ASA, Coversyl 4mg OD.
183/84, AFib 180 NSR 80 with fluid. Afebrile. Wasted: 47 kg.
Disoriented x 3, agitated, resting tremor. No focal neuro signs.
Clinically dry: dry MM, flat JVP, no edema. PPP. Lungs clear.
No active joints, rashes, lymphadenopathy, bruits.
sCr 287, urea 40.
U/A: 3+ protein, prot/Cr=469 mg/mmol, 26-50 RBC, occ WBC, occ hyaline casts.
Urine C+S: no growth
Na=153, K/TCO2/Cl N. sAlbumin=19, Ca=1.73, Po4=1.63, Mg N. LFTs, NH3, CK N.
CBC: Hb 138 (MCV 95), Plt 159, WBC 6.1. Smear: no schistos, no hyperseg PMNs
Renal U/S: N sized kidneys, increased echogenicity. No masses/hydro.
Course in Hospital
-Admitted to CTU with confusion ?EtOH withdrawal, ARF, hypovolemia, AFib.
-Supportive care: IV crystalloid, benzos
-sCr: 284 (6/12) 316 (6/13) 315 (6/14)
-Nephro consult (6/15): suspected pre-renal ARF with underlying intrarenal process.
Too combative for biopsy: repeat urine studies and serology
-SPEP/UPEP –ve for M-band, C3 0.73 (N 0.8-2.0), C4 N, anti-GBM negative
June 20: pANCA +ve, cANCA –ve, ANA+, dsDNA –ve
Urine microscopy: ++RBC casts and heme-granular casts
Minimal improvement in mental status
CT head: non-acute ischemic lesions L frontal lobe and peri-ventricular white matter
-June 21 (Wednesday): RENAL BIOPSY (after sedation)
Arteritis with fibrinoid change and medium sized
arteries with consequent tubular damage and
membranoproliferative glomerulonephritis with
occasional crescent formation.