U06-23415

#813628120

• SCr 184

• Proteinuria 3+

• Hematuria 3+

• ? IgA

• ? RPGN

45 year old male admitted to GIM in October 2006• Presented with purpuric rash over lower extremities • 1 week hx of Indomethacin use prior to admission• Skin biopsy negative for IgA, ANCA, ANA neg,

complements normal, Hep B, Hep C, HIV neg• 1+ Hgb and 1+ protein on UA• Creatinine 70umol/L• Quant Ig slightly high IgA 4.23• Started on prednisone 50mg per day by GIM• No indication for biopsy, pt discharge with O/P followup

with nephrology

• seen by GIM and Rheumatology in followup in last week of November• Prednisone tapered to 20mg day• Peripheral edema• Creatinine increased from 70umol/L to 184 umol/L• UA 3+ protein, 3+ Hgb, 24 urine 3gm/day prot• ANA, ANCA negative• Pt reports dark colored urine• Urgent biopsy done Dec 7, 2006

IF

• IgG- Mild mesangial staining. • IgA- Mild to moderate mesangial staining. • IgM- Negative.• C3- Moderate mesangial staining. Moderate

vascular staining. • C1q- Negative.• Kappa- Negative.• Lambda- Mild mesangial staining. • Fibrinogen- Mild to moderate interstitial staining. • Albumin- Negative.

IgG

IgA

C3

C3

lambda

fibrin

EM

• Will be ready in the coming weeks

DiagnosisRenal Biopsy:• Biopsy of marginal adequacy showing

diffuse proliferative IgA nephropathy with possible superimposed acute allergic interstitial nephritis of unknown etiology.