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RENAL UNIT CASE 13 |
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Clinical History: A 57-year-old white male with a history of coronary artery disease was found to have ankle edema on a follow-up clinical visit. A diagnosis of heart failure was made, and he was started on digitalis and diuretics. However, his urinalysis showed Sp. Gr. of 1.003, pH 6.0, negative for glucose, 2+ protein, 0-2 WBC and no RBC/hpf, and a few granular casts. Blood studies drawn at the time of the office visit revealed normal electrolytes and liver function tests, albumin of 2.6g/dl, and creatinine of 1.3 mg/dl. Questions: 1. What further information would you want? 2. What is your clinical diagnosis of the renal disease? What would you do next? 3. A renal biopsy was performed. All the glomeruli looked like the one shown in Figure 1. What is the morphologic pattern of injury? 4. Immunofluorescent staining for IgG is shown in Figure 2; staining for C3 was similar. Figure 3 is a representative electron micrograph. What are the important findings? What do they tell you about the pathogenesis of the process? What is your diagnosis? 5. With a diagnosis established, what further studies should be done? 6. What is the prognosis and therapy for this disease? |
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