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RENAL UNIT CASE 12 |
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Clinical History: A previously healthy 24-year-old black male construction worker noted that he tired easily and that he had difficulty putting on his shoes when he changed from his work books to shoes after a day’s work. He was seen in an Emergency Room after an on-the-job injury. PE: BP 150/90, P 80, R 22. He had a laceration of the left hand, and 2+ edema of the ankles and lower legs. His chest was clear and he had a normal sinus rhythm with no murmurs. The rest of the physical exam was normal. Lab: Chest film normal. Glucose 120 (non-fasting), electrolytes normal, creatinine 1.4, calcium and phosphorus normal, albumin 2.4g, cholesterol 350. Urinalysis - pH 6.5, Sp Gr 1.020, glucose negative, protein 3+, sediment showed 5-10 RBC and 2-3 WBC/hpf, and occasional waxy and granular casts. Questions: 1. What is your presumptive clinical diagnosis of his kidney disease? 2. What other studies would you perform at this time? 3. A renal biopsy was performed. Most of the glomeruli resembled the one in Figure 1, but about a third resembled the one in Figure 2. What is your morphologic interpretation? 4. Immunofluoresence and electron microscopy were non-contributory. What is your clinicopathologic diagnosis? What do you know of its cause(s) and pathogenesis? Would you seek further data in this case? What is the natural history of the disease? |
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