U74-1807 #EGH 74-4670 No clinical information. 68 YOM Was sent from Norwood for evaluation of Acute Renal Failure and worsening extremities edema. His.

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Presentation transcript:

U #EGH No clinical information

68 YOM Was sent from Norwood for evaluation of Acute Renal Failure and worsening extremities edema. His Baseline Cr was 300’s (Aug06). the day of admission his Cr was 650’s Was sent to UofA hospital for evaluation of Acute on Chronic Renal Failure.

PMH: SLE: Not Biopsy proven, ds-DNA neg MPGN: Biopsy done in 1974 CAD: S/P CABG few years ago (5 vessels) Cirrhosis: based on U/S. not biopsy. etiology NASH vs. Cryptogenic Cirrhosis Seizure Gout HTN Dyslipidemia 3 rd Degree Heart Block  DDDR pacemaker A.Fib  ex- warfarin therapy (Warfarin was D/C on Aug)

Labs: (day of admission) INR: AG ALT&AST:45 & 46 T. Bili: 20 U Na Urine S/G:

Hospital Course: With Diagnosis of Acute on Chronic (pre- renal) patient was started on Lasix 40 Q day and Spironolactone 100 mg QD  then Lasix 80 BID. U/O: 1000 cc/day (average) R IJ was placed and HD started.

Light microscopy (slides are not available) 2 glomeruli showing: Moderately severe membrano-proliferative changes: –Mesangial cell hyperplasia in axial regions of tufts –Swelling of podocytes and endothelial cells –Patchy thickening of glomerular basement membranes –Capillary lumina are narrowed Hypertrophy and hyperplasia of parietal epithelial cells Peri-glomerular fibrosis

IF IgG- Moderate to marked granular deposits. IgA- Trace amounts. IgM- Trace amounts. C- Moderate to marked granular deposits.

Original diagnosis (1974) Renal Biopsy: Membrano-proliferative glomerulonephritis, –Process is active –Most consistent with a diagnosis of immune- complex induced GN

Upon review of EM pictures EM supports a diagnosis of post-infectious or membranous GN. Presence of numerous subepithelial deposits, somewhat more irregularly spaced than would be usual for membranous.