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 allergiesPresented 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 pastAvailable prior creatinine in Feb 2001 of 91mol/L and UA was negativeOn admission:

creat 306mol/LUA showed 3+ protein and 3+ bloodANA +, DS DBA -, Hep B&C -, ANCA -, anti GBM-, C3&C4 normal, SPEP normal, cryo negative

RUS showed normal kidneys

• 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

IF

IgA

IgA

Kappa

Fibrin

Diagnosis:Renal Biopsy:Focal proliferative and necrotizingglomerulosclerosis ,consistent with IgAnephropathy/Henoch-Schonlein purpuraNecrotizing arteritis of small arteries.