28058320 u06-110

28058320U06-110

54y/o man with recent dx of HI +DM.creatinine increasing rapidly 140-200 in 6 months.ACR low at 5.3, 2+ hematuria x 2-3 years with negative cystoscopyRUS (normal) 244 unit calcium/oxalate normalNegative serologies, normal C3/C4HG BM negative. ANCA negative

» BB 54y male referred for increasing creatinine Dec 2005

• HT diagnosed 2005, SBP in 120-140s, recently increasing to 160s

• DM diagnosed 1/04 with HBA1c of 12.5%, glucose control improved fast, 2/05 HBA1c 6.4%; 11/05 HBA1c 5.8%

• Microscopic hematuria x few years, renal US normal, cystoscopy negative May 2005Orfila et al

• Other med hx: remote stones, hypothyroid x 1 yr, no DM complications

• Meds: glipzide 80 bid, Metformin 500 bid, HCTZ 25 mg, Diovan 160 mg q day, Synthroid 0.75 q day, Norvasc 5 q day, and aspirin 81 mg daily.

• Serologies negative, 24h U Ca/oxalate normal, U eos neg, ACE normal, imaging normal – renal, retroperitoneaum, hemolysis w/up neg

date 1/04 2/05 7/05 11/05 12/8 12/19 1/3 1/6 1/11 2/6 2/23

creat 93 132 125 160 201 210 232 225 285 180 239

ACR 7.3 1.1 8.1 5.34 9.55

heme 1+ trace 2+

• IgG- moderate linear GBM staining , common finding in diabetes

• IgA- moderate to strong mesangial staining• IgM- negative• C3- moderate mesangial staining,moderate

vascular staining• C1q- negative• Kappa- negative• Lambda- negative• Fibrin- moderate interstitial staining• Albumin- moderate linear GBM and TBM

staining , common finding in diabetes

IF

IgG

IgA

C3

C3

Fibrin

Albumin

Diagnosis:Renal Biopsy:Diabetic glomerulopathy with superimposed IgA nephropathy