1. U05-15054

2. Clinical History A 53 year old man who had very little or no medical care in the past, presents to ER with the only complaint of insomnia. His BP was 260/120 and Creatinine 240. In 1993 he was told by a doctor that he had "mild hypertension" but was treated only for a few months. Not on any meds.

3. P/E showed audible S4, fundi could not be examined properly. Labs. UA 3+ proteinuria, > 50 RBC/hpf, Urine Pr/Cr 257 mg/mmol, serology for GN normal or negative. U/S mild- moderate increased cortical echogenecity.

10. Immunofluorescence IgG – Negative IgA – Negative IgM – Mild mesangial staining, Moderate vascular staining C3 – Mild Vascular staining C1q – Negative Kappa – Negative Lambda – Negative Fibrinogen – Negative Albumin - Negative

11. IgM

12. C3

13. Fibrin

17. Diagnosis: Malignant Hypertension with Thrombotic Microangiopathy and Chronic Parenchymal Scarring No definitive evidence of underlying primary glomerular disease