U

History is that of a 12 y/o male presenting with a few day history of vomiting, facial swelling, fatigue and oliguria. Hypertensive only at times of vomiting. Also c/o diplopia. No rash, or joint symptoms. Did have a low grade fever prior to coming in. No complaints of sore throat. Might have had some skin lesions/scabs from pruritus. On admission, found to be in ARF with urea 48, Cr > 600, oliguria, normal Hb, and enlarged echogenic kidneys. Serology +ve for low C3 (<0.10), antiDNAseB titre elevated, throat swab +ve for Strep. Dialysis started on day 2 of admission. Biopsied to confirm diagnosis.

Immunofluorescence IgG – Moderate to strong coarsely granular capillary loop staining IgA – Negative IgM – Negative C3 – Moderate vascular staining, strong coarsely granular capillary loop staining C1q – Negative Kappa – Mild to moderate coarsely granular capillary loop staining Lambda – Mild to moderate coarsely granular capillary loop staining Fibrinogen – mild interstitial staining Albumin – mild hyaline droplet change in tubular cytoplasm

IgG – coarsely granular capillary loop staining

C3 - coarsely granular capillary loop staining

Kappa - coarsely granular capillary loop staining

Lambda - coarsely granular capillary loop staining

Fibrin – mild interstitial

Albumin – mild hyaline droplet change

Diagnosis Post infectious Glomerulonephritis