U05-11480

#009N3585833

• Recurrent edema with most recent episode proteinuria with creat > 300

DOB: 26 Jan 1981

• 25 yo Caucasian female. • Medical History:

1. Normal renal function with Baseline Cr of 56 and bland U/A 2001

2. Possible Pyelonephritis 6 years ago – hospital admission and antibiotic

3. Obese – BMI 35 kg/m2

4. Smoker5. Bronchitis X 16. Depression7. Remote Cocaine/crack. No IVDU. HBV/HCV/HIV

negative

Acute Renal Failure June 2005. • Two day history bilateral flank pain and urinary hesitancy. • Initial renal work-up: Cr 182 and Urine +3 protein, trace hgb, no

leuks, 10 WBC. Culture negative but did receive IV Cefotaxime 2 hour before urine collection.

• No ptn/cr urine at presentation but PAD 3 ptn/Cr 27.45 mg/mol. • Immunologic investigations in June unremarkable: neg-ANA, neg-ds-DNA and neg-ANCA (weakly), normal C3, C4. Normal kidney ultrasound.

• HCV/HCV/HIV negative• Subsequent investigations: 08/2005 Cr 79 and U/A normal. 09/2005

U/A 2+ ptn, 4+ blood, 1+leuks.

Renal Biopsy post-presentation day 5 (June 10 2005)

• Referred Sept 2006 for subjective bilateral flank pain daily and pedal edema. Creatinine 60. Urine neg for ptn/hgb. No ptn/cr. Normal liver enzymes and function, and normal TSH.

• History unremarkable for pulmonary symptoms, those suggestive of chronic suppurative process, connective tissue disease or an auto-immune condition except parathesias and pre-syncopal episodes (non-witnessed). No objective findings confirming deficit in power, tone or DTRs. Neurology to see in October

IF

• IgG- Negative.• IgA- Trivial to mild mesangial staining. • IgM- Moderate mesangial staining. • C3- Trivial to mild mesangial staining. • C1q- Negative.• Kappa- Negative.• Lambda- Negative.• Fibrin- Mild interstitial staining.• Albumin- Negative.

IgA

IgM

C3

Fibrin

DiagnosisRenal Biopsy:

• Focal glomerular sclerosis with relatively mild changes by light microscopy.