U07-1212 #819597120 46 y.o. F New diagnosis of lupus Normal creatinine.

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Presentation transcript:

U # y.o. F New diagnosis of lupus Normal creatinine

L.G. 46 y black female new Dx of SLE in Nov 2006 with ANA +, DS DNS 98%, C3 0.35, C4 < 0.05 Initial sx of joint pains, weight loss > 40 lb in last year, night sweats etc. U micro in Nov 3+ protein, 3+ blood, creatinine 78, PCR 110 Given naprosyn and plaquenil In early Dec 2006 admitted with LGI bleed, possible ischemic colitis. SBP s. Started on prednisone Had ATN with creat 173 → 74 post hydration Anemic with DAT + (n LDH, bili), ENA +, pANCA +, RF 27, anticardiolipin mild +, cryo + UA showed ++ granular casts, + rbc, some dysmorphic, no rbc casts Re-admitted after Christmas with pericarditis BP now controlled with 4 agents, on ACEI, creat 106, PCR 114, C3 0.3, C4 < 0.05

IF IgG- Mild mesangial staining. Mild granular peritubular staining. IgA- Trivial to mild mesangial staining. IgM- Negative. C3- Mild to moderate mesangial staining with some extension to peripheral capillary loops. Mild granular peritubular staining. C1q- Moderate mesangial staining with some extension to peripheral capillary loops. Moderate granular peritubular staining. Kappa and lambda- Mild to moderate mesangial staining with some extension to peripheral capillary loops. Moderate granular peritubular staining. Fibrinogen- Mild interstitial staining. Albumin- Negative.

IgG

IgA

C3

Clq

Kappa

Lambda

Fibrinogen

EM Is pending

Diagnosis Renal Biopsy: Diffuse proliferative lupus nephritis of mild activity and mild chronicity with hypertensive vascular disease and probable arteriolar thrombosis