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RENAL UNIT CASE 6 |
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Clinical History: A 22 year old white male factory worker was well until February 1976 when he had a flu-like illness with fever, muscle aches, and cough. Over the next few weeks the fever and myalgia decreased but the cough persisted and there were some episodes of hemoptysis. In March the hemoptysis became severe and he had dyspnea. He also felt weak, nauseated and without appetite. The BP was 150/100 mmHg. Rales were heard in the lungs and the chest was dull to percussion. He had mild ankle edema. A chest X-ray showed patchy bilateral density suggesting an alveolar infiltrate. The hematocrit was 31%, WBC 8500/mm3. BUN was 71 mg/dl and serum creatinine was 5.0 mg/dl. Two days later the creatinine was 8.1 mg/dl. Urinalysis: color, cloudy brownish red; specific gravity, 1.010; glucose 0; protein 1+. There were 50-100 RBC/HPF, 20 WBC/HPF and casts such as that in Figure 1. Questions: 1. What is the clinical diagnosis? 2. What are some diseases that cause this combination of renal and pulmonary problems? Can you exclude acute post-streptococcal GN? 3. A kidney biopsy was done in which most of the glomeruli looked like the one in Figure 2. What does it show? 4. Figure 3 and Figure 4 show immunofluorescence stains for IgG and fibrinogen respectively. What do they tell you about the pathogenesis of the disease? 5. Can you now make a clinical pathological diagnosis? 6. If renal function continued to deteriorate would you recommend kidney transplantation? 7. What is the prognosis? 8. What biopsy finding would you expect in polyarteritis nodosa? (see Figure 5 and Figure 6). 9. Summarize the usual 4 features of this glomerular disease. |
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