U06-3222#657376720

28yo Nigerian Canadian, born in Toronto HPIPresented with a several day history of intractable N&V, bilateral flank pain, fever and generally feeling unwell. Was seen in ER. Cr was normal and U/A showed 6-10 WBC, 26-50 RBC and occasional granular and hyaline casts. He was referred to Dr. Bradley who initiated a GN work-up.In the interim, the N&V continued and he was admitted to hospital a few days later. Cr remained normal. CK increased to > 500, and urine was + for myoglobin so he was treated for rhabdomyolysis. Several days following admission he acutely developed peripheral edema and ascites, N&V remain intractable. 48 hours following this, Cr began to rapidly increase from 80 - ~ 550.

U06-3222

#657376720

PMH: nil Abdominal U/S: increased renal echogenicity, edema of the bowel, ascitesCT abdomen: Bowel wall edemaCr: 550, electrolytes N, CBC NANCA, Ds-DNA, C4, protein electrophoresis = normalANA +, IgA & IgG increased, C3 0.57, albumin 19 PE: mild hypertension, ascites, peripheral edema, decreased perianal and scrotal sensation, mild incontinence of stool and urineNo skin or MSK abnormalities 

• IgG-Strong coarsely granular capillary loop staining• IgA- Mild to moderate coarsely granular capillary loop

staining• IgM- Mild coarsely granular capillary loop staining• C3- moderate coarsely granular capillary loop staining• C1q- mild to moderate coarsely granular capillary loop

staining• Kappa-moderate coarsely granular capillary loop staining• Lambda- moderate coarsely granular capillary loop

staining• Fibrin- Mild interstitial staining• Albumin- mild hyaline droplet change in tubular

cytoplasm

IF

IgG

IgA

IgM

C3

Clq

Kappa

Lambda

Fibrin

Albumin

Diagnosis:Renal Biopsy

Lupus nephritis Class V ,Membranous lupus nephritis mixed with focal lupus nephritis Class IIIA with active lesions (2003 ISN/RPS Classification).