u06-19814 #489287010 19 y.o. female with pneumonia creatinine proteinuria very low c3, c4

U06-19814

#489287010

• 19 y.o. female with pneumonia creatinine

• proteinuria

• very low C3, C4

• 19 year F transferred from High Level Hospital with Right Upper Lobe pneumonia, Anemia and ARF.

• 10 days prior to this admission patient had productive cough with fever.

• Symptoms worsen with time and with SOB, N and V was admitted to High Level Hospital.

• Treated with Cefotaxime and Azithromycin for URL pneumonia.

• Elevated serum Cr was presumed secondary to volume depletion and treated with IV Fluid (Cr decline from 220 to 140).

• In the ER at UAH patient needed more Oxygen and finally got intubated and admitted to ICU. Blood Culture positive for S. Pneumoniae.

Lab: Day of admission: October 17,2006– C3: 0.23– C4: <0.05– Crea: 143 (stable around 130-140 on day 4)– Urea: 13– WBC: 5.8– Hgb: 80– Phos: 1.52– CK: 128– Pro/Crea: 428– Urine Microscopic: ? + RBC cast– IgG: 12.16– IgA: 2.11– IgM: .97– dsDNA: 28

Biopsy done in the ICU on 18-OCT-2006

IF• IgG- Moderate to strong coarsely granular capillary loop

staining and mesangial staining. Moderate granular peritubular staining.

• IgA- Moderate coarsely granular capillary loop staining. • IgM- Moderate coarsely granular capillary loop staining. • C3- Moderate to strong coarsely granular capillary loop

staining. • C1q- Moderate coarsely granular capillary loop staining.

Moderate granular peritubular staining. • Kappa- Moderate coarsely granular capillary loop staining.

Mild granular peritubular staining.• Lambda- Moderate coarsely granular capillary loop staining.

Mild granular peritubular staining.• Fibrinogen- Mild interstitial staining. • Albumin- Negative.

IgG

IgG

IgA

IgM

C3

Clq

Clq

Kappa

Kappa

Lambda

Lambda

Fibrinogen

DiagnosisRenal Biopsy:

• Diffuse lupus nephritis with global proliferative active lesions

• Class IV-G (A)