226757920 U06-2835 Lupus.Nephrotic syndrome now. Normal creat.  C3/C4, ANA +, ? Membranous ?antiphospholipid Ab syndrome.

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Presentation transcript:

U Lupus.Nephrotic syndrome now. Normal creat.  C3/C4, ANA +, ? Membranous ?antiphospholipid Ab syndrome

U Yr Female with diagnosis of SLE On prednisone 7.5mg/d, Hydroxy- chloroqiune 200mg/d for control of Systemic features. Referred for Proteinuria 2 yrs ago. Creatinine umol/l. protein mg/d Last visit edema(new onset) Creatinine 80umol/5grams proteinuria Albumin 28g/L C C ANA+ve, anti DNA 76( baseline 15-30) ENA -ve UA 3+ protein MIC WBC's RBCs.. HB Haptoglobin 3.22 LD 185 FOB -ve Ferritin 54???? D/D Membranous Mixed

IgG- moderate to strong coarsely granular capillary loop staining IgA- moderate coarsely granular capillary loop staining IgM- moderate coarsely granular capillary loop staining C3- mild to moderate coarsely granular capillary loop staining/ mild mesangial staining C1q- mild to moderate coarsely granular capillary loop staining/ mild mesangial staining Kappa- inadequate tissue Lambda- moderate coarsely granular capillary loop staining Fibrin- moderate interstitial staining Albumin- mild hyaline droplet change in tubular cytoplasm IF

IgG

IgA

IgM

C3

Clq

Lambda

Fibrin

Albumin

Diagnosis: Renal Biopsy: Lupus nephritis. (A)Membranous and focal Proliferative Glomerulonephritis Pattern. (B)Moderate Activity (NIH score 8/24) and Low Chronicity (1/12).