1. U06-19814 #489287010 19 y.o. female with pneumonia  creatinine proteinuria very low C3, C4

2. 19 year F transferred from High Level Hospital with Right Upper Lobe pneumonia, Anemia and ARF. 10 days prior to this admission patient had productive cough with fever. Symptoms worsen with time and with SOB, N and V was admitted to High Level Hospital. Treated with Cefotaxime and Azithromycin for URL pneumonia. Elevated serum Cr was presumed secondary to volume depletion and treated with IV Fluid (Cr decline from 220 to 140). In the ER at UAH patient needed more Oxygen and finally got intubated and admitted to ICU. Blood Culture positive for S. Pneumoniae.

3. Lab: Day of admission: October 17,2006 –C3: 0.23 –C4: <0.05 –Crea: 143 (stable around 130-140 on day 4) –Urea: 13 –WBC: 5.8 –Hgb: 80 –Phos: 1.52 –CK: 128 –Pro/Crea: 428 –Urine Microscopic: ? + RBC cast –IgG: 12.16 –IgA: 2.11 –IgM:.97 –dsDNA: 28 Biopsy done in the ICU on 18-OCT-2006

4. IF IgG- Moderate to strong coarsely granular capillary loop staining and mesangial staining. Moderate granular peritubular staining. IgA- Moderate coarsely granular capillary loop staining. IgM- Moderate coarsely granular capillary loop staining. C3- Moderate to strong coarsely granular capillary loop staining. C1q- Moderate coarsely granular capillary loop staining. Moderate granular peritubular staining. Kappa- Moderate coarsely granular capillary loop staining. Mild granular peritubular staining. Lambda- Moderate coarsely granular capillary loop staining. Mild granular peritubular staining. Fibrinogen- Mild interstitial staining. Albumin- Negative.

5. IgG

7. IgA

8. IgM

9. C3

10. Clq

12. Kappa

14. Lambda

16. Fibrinogen

17. Diagnosis Renal Biopsy: Diffuse lupus nephritis with global proliferative active lesions Class IV-G (A)