1. 53 yo female referred for elevated SCr (178 mmol/l, 28 ml/min) and change in symptoms….? connective tissue disease
Dx of hypocomplementemic urticarial vasculitis ~ 15 yrs ago
renal Bx same time  MPGN
? cryoglobulins (+)
C1 esterase inhibitor low
given steroids+cyclophosphamide twice between
on dapsone since 1999
SCr since mmol/l
was “severely nephrotic” at the time
SCr now 149 mmol/l
urine now
3+ hematuria, 1+ proteinuria,
P:C ratio 42 mg/mmol
Hgb x 10+yrs
microcytic, low retics
C (), ANA neg, anti dsDNA Ab neg, ENA neg
PTT, PT normal

2. U #
Previous Dx of hypocomplementemic urticarial vasculitis. Now ?Lupus. (Pre kidney Bx ~ 10 yrs ago → not definitive). Native L kidney.

9. IF
IgG- Moderate coarsely granular capillary loop staining. Moderate granular peritubular staining
IgA- Negative
IgM- Negative
C3- Mild to moderate granular capillary loop staining. Mild to granular peritubular staining
C1q- Moderate granular capillary loop staining. Moderate granular peritubular staining
Kappa- Moderate coarsely granular capillary loop staining. Mild granular peritubular staining.
Lambda- Trivial to mild granular capillary loop staining
Fibrin- Trivial to mild interstitial staining
Albumin- Mild hyaline droplet change in tubular cytoplasm

10. IgG

11. IgG

12. C3

13. Clq

14. Clq

15. Kappa

16. Lambda

17. Fibrin

18. Albumin

26. Diagnosis: Renal Biopsy: Biopsy of marginal adequacy (only two glomeruli by light microscopy) with changes compatible with diffuse proliferative lupus nephritis of mild activity and moderate chronicity with extensive peritubular capillary deposits with fingerprint-like substructure diagnostic of SLE.