U # y.o. male Hemoptysis, pulmonary haemorrhage

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U06-20612 #87734-4041 29 y.o. male Hemoptysis, pulmonary haemorrhage Active urine sediment Creat 1200 mol/L Serology pending

29 Yr old male, Pakistani descent past medical Hx 29 Yr old male, Pakistani descent past medical Hx ? Flu like symptoms – 4 days, then SOB, chest pain and hemoptysis. Admited to ICU Oct 27 – intubated for pulm Hge/ hypoxia/ resp failure bronchoscopy: diffuse alveolar Hge required 7 units of Blood Labs: s.Cr at presentation: 1274 µmol/l urine: 3+ ptn, 3+ Hb, +ve casts ptn/Cr : 514 mg/mmol ANCA, anti-GBM, anti DNA, HBsAg, HCV Ab, : are negative cryo : pending started on PRISMA in ICU biopsy…

IF IgG- Negative. IgA- Negative. IgM- Negative. C3- Mild vascular staining. C1q- Negative. Kappa- Negative. Lambda- Negative. Fibrin- Mild to moderate interstitial staining. Albumin- Negative.

C3

Fibrin

EM Will be ready in the coming weeks

Diagnosis Renal Biopsy: Probable chronic glomerulonephritis with extensive glomerulosclerosis and parenchymal scarring. Polymorph aggregates in collecting ducts suggesting ascending bacterial infection.

Comment Despite evidence of ascending bacterial infection, the most likely cause of disease is chronic GN. The changes seen in the 2 non-sclerotic glomeruli support the idea of primary glomerular disease. However, various glomerular changes would be expected with compensatory hypertrophy so one cannot completely exclude the possibility of primary tubulointerstitital disease.