Case 125 -- Renal Insufficiency

Contributed by Jianzhou Wang, MD., PhD., Sheldon Bastacky, MD
Published on line in February 1998


PATIENT HISTORY:

The patient is a 65 year old woman with systemic rheumatoid arthritis associated with vasculitis (positive sural nerve biopsy). She developed renal insufficiency with a serum creatinine of 2.0 beginning approximately 9 months ago, presumed to be secondary to vasculitis. She was treated with IV Cytoxan and Solumedrol from 12/95 to 5/96, with Cytoxan changed to po at that point because of recurrent cellulitis. Over the past one month, the creatinine has increased to 3.5 mg%. The patient has nephrotic syndrome. Blood pressure is 134/86. Medications include antibiotics, steroids, po Cytoxan, and previously low dose coumadin (discontinued 9/30).

LABORATORY DATA:

Creatinine 3.7 mg% (9/30/96), BUN 59 mg% (9/30/96), urine protein 1.8 gm/24hrs (7/10/96), ANA negative, C3 95, C4 24, urine sediment - inactive (1 WBC/hpf; 6/18/96). Kidneys are bilaterally decreased in size by ultrasound.


GROSS DESCRIPTION

MICROSCOPIC DESCRIPTION

ELECTRON MICROSCOPIC EXAMINATION

FINAL DIAGNOSIS


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