U03-2654 #566726030 31 year-old, born in India, has lived in Canada since 1989. Initially presented Feb 2003 with a Cr of ~ 300 (212 Sep 2002, 122 Dec.

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Presentation transcript:

U # year-old, born in India, has lived in Canada since Initially presented Feb 2003 with a Cr of ~ 300 (212 Sep 2002, 122 Dec 1999)and a bland U/A. Only significant history was mild SOB, red lumps on shins and parotid gland enlargement in Parotid gland biopsy showed granulomatous sialadenitis. TB history: BCG vaccine as a child, positive Mantoux in 1996, no known exposure to TB. CXR normal, all serology and protein electrophoresis normal, AFB negative. Biopsy #1

IgG-Trivial to mild mesangial staining- occasional interstitial plasma cells with cytoplasmic staining IgA- Moderate mesangial staining, occasional interstitial plasma cells with cytoplasmic staining IgM- Mild mesangial staining C3- Moderate mesangial staining C1q- Negative Kappa-Moderate mesangial staining Lambda- Mild mesangial staining Fibrin- Moderate interstitial staining Albumin- Negative IF

Diagnosis: Renal Biopsy: Chronic Granulomatous interstitial nephritis. (A) Consistent with renal sarcoidosis. (B) Rule out infectious causes

U # He was treated for renal sarcoid with oral prednisone 1mg/kg for 3 months and then tapered to discontinue over the next 6 months (October 2003): 170’s. Also had 2 drug TB preventive therapy with isoniazid and Rifampin + Vit B6 x 6 months. Well for 1 year then presented (Oct 2004) with another acute increase in Cr (327) with a 10 Kg weight loss. No systemic evidence for sarcoid. Biopsy #2.

Diagnosis: Renal Biopsy: Severe Active Chronic Tubulointerstitial nephritis,probably Sarcoidosis. Mild mesangioproliferative changes consistent with residual IgA Immune Complex Disease.

U # Re-treated with steroids x 8 months (May 2005). Baseline CR back to 170. Dec 2005 Cr increased to 221, Feb 3 rd 275….Biopsy #3, back on steroids.

IgG-Negative IgA- Trivial to mild mesangial staining IgM- Mild mesangial staining C3- Mild vascular staining,Moderate mesangial staining C1q- Negative Kappa-Negative Lambda- Negative Fibrin- Moderate interstitial staining Albumin- Negative IF

IgA

IgM

C3

Fibrin

Diagnosis: Renal Biopsy: Active Chronic Interstitial Nephritis with giant cell formation consistent with sarcoidosis. Considerable progression of Glomerulosclerosis since 2003 biopsy Progression has also occurred in the degree of glomerular scaring since the 2004 biopsy. This is harder to assess because that biopsy contained relatively few glomeruli.