u06-16889 #803963500 30 y.o. male with increased proteinuria, arthralgia and lower limb petechial...
TRANSCRIPT
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U06-16889
#803963500
• 30 y.o. male with increased proteinuria, arthralgia and lower limb petechial rash.
• Hypertension
• ? Renal vasculitis
• ? Henoch-Schönlein purpura
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30 yo male with Nephrotic Syndrome
• Acute onset lower extremity rash and edema
• Active urine sediment, hypertension, Cr 146
• 6g protein / 24 hrs
• Urgent referral within 1 week
• PHx: Strep throat, NEC as a neonate
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In Clinic
• Spontaneous clinical improvement– Resolved edema, Cr 106, rash resolving– Still hypertensive and proteinuric 2g/24hrs– LE arthralgias persist, mild diarrhea– Serology all negative except: mildly depressed
compliment levels, positive ASOT– No history of URTI
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Tx
• Diuretics, ACEi, ARB
• Follow up bloodwork at biweekly intervals shows increasing creatinine
• Renal Biopsy performed
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IF• IgG- Negative.• IgA- Mild mesangial staining. • IgM- Negative.• C3- Moderate vascular staining. Mild mesangial
staining.• C1q- Negative.• Kappa- Negative.• Lambda- Negative.• Fibrinogen- Strong staining of glomerular crescents. • Albumin- Negative.
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IgA
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C3
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Fibrin
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DiagnosisRenal Biopsy:
• Crescentic diffuse proliferative glomerulonephritis with IgA deposition by IF suggesting Henoch-Schönlein purpura.
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Developed Pericarditis
• Acute pleuritic chest pain– VQ scan negative
• New rash
• Referred to ID: ? Rheumatic Fever
• Placed on penicillin prophylaxis