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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. - PowerPoint PPT Presentation
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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.