1. 226757920 U06-2835 Lupus.Nephrotic syndrome now. Normal creat.  C3/C4, ANA +, ? Membranous ?antiphospholipid Ab syndrome

2. 226757920 U06-2835 42 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 70-80 umol/l. protein 300-500mg/d Last visit edema(new onset) Creatinine 80umol/5grams proteinuria Albumin 28g/L C3 0.58 C4 0.04 ANA+ve, anti DNA 76( baseline 15-30) ENA -ve UA 3+ protein MIC 25-50 WBC's 11-25 RBCs.. HB 113-116 Haptoglobin 3.22 LD 185 FOB -ve Ferritin 54???? D/D Membranous Mixed

3. 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

4. IgG

5. IgA

6. IgM

7. C3

8. Clq

9. Lambda

10. Fibrin

11. Albumin

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