U06-24697

#32251-4521

• Healthy young male 28 Y came in with bilateral flank pain

• Creat 155 went up to 286

• Received solumedrol 1 gm last night

• Today’s creat in 272

• R/O GN

28/M- Caucasian

• Came in with bilateral flank pain 1-2 days prior to admission.

• Flank pain started gradually. Not radiating. No Dysuria, No Hematuria, No fever, No Chills, No sore throat and No Hx of Kidney stones.

• Two-Three days prior to admission patient took 12-14 Advils (?400mg) for “Holiday Induced Headache” over 36-48 hours.

PMH:

• Anxiety: on Citalopram 100 mg/day (for about 4 years).

• NO Hx of Kidney Disease, HTN, DM

Allergy: NKDA

Labs on admission:

• Na, K, Cl, Anion Gap, Hgb, Platelet: NL• WBC:7K, Pmn 65%, Lymph 25%, Eosi 1%• Creat 155 (baseline Cr: 80-90 mmol/L),

Urea 10 mmol/L• C-Reactive Protein: 30 mg/L• U/S of the Kidney: NL• U/A: pH: 5.50, SG: 1.010, Protein: +2,

Hgb: +3, WBC 5-10

Physical Examination:

• Vitals: within Normal Limits• Lungs: CTA bilateral• Skin: No rash (except the flushing

of the face)• Extremities: No pedal edema.

Hospital Course:

• Crea Increased to 280 despite of IVF therapy.

• Patient was started on Steroid Pulse• Biopsy was scheduled.

…..And Biopsy showed…

IF

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

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

IgA

IgM

C3

C3

Lambda

Fibrinogen

• EM is pending

DiagnosisRenal Biopsy:• Acute allergic interstitial nephritis with

signs of tubular injury.

• No definitive evidence of primary glomerular disease.