Nephrology Pathology Rounds Oct 21/05

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Presentation transcript:

Nephrology Pathology Rounds Oct 21/05

Clinical History 44 year-old male. Presented in Spring 2005 with Cr 190 and protein > 4g/day Cr: July 2002 - 78; Sep 2003 - 105 with 1.8g protein/day; July 2004 197; October 2004 173 with 4.6g protein/day Past Medical history: type 2 DM x 15 years with retinopathy (very poor glycemic control); htn, dyslipidemia, PVD, Hepatitis C, smoker, minimal ETOH No history of NSAID use, herbal remedies, gout, rheumatologic diseases. Medications: metoprolol, teveten, metformin, hydrochlorothiazide, lipitor, renedil, s/c insulin

Clinical History Examination: volume overloaded, hypertensive, decreased peripheral pulses, nil else. Investigations: U/S - normal size kidneys with subtle increase in cortical echogenicity; U/A - 3+ ptn, 2-3+ RBC; Normal serology including C3, C4, ANA, ANCA, anti-DS DNA, immunoglobulins ( except borderline increase in IgG), and cryoglobulins

Immunofluorescence IgG – Mild linear GBM staining – a common finding in diabetes IgA – Trivial to mild mesangial staining IgM – Moderate mesangial staining C3 – Moderate vascular staining C1q – Mild mesangial staining Kappa – Negative Lambda – Negative Fibrinogen – Mild interstitial staining Albumin – Moderate linear GBM and TBM staining

IgG

IgA

IgM

C3

Clq

Fibrin

Albumin

Albumin

Electron Microscopy

Diagnosis Focal Proliferative Immune Complex Glomerulonephritis superimposed in an early Diffuse Diabetic Nephropathy