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

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U # ↑ SG 300. Proteinuria, Vasculitis rash. Native (L) Kidney

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

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

Kappa

Fibrin

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