1. 28058320 U06-110 54y/o man with recent dx of HI +DM. creatinine increasing rapidly 140-200 in 6 months. ACR low at 5.3, 2+ hematuria x 2-3 years with negative cystoscopy RUS (normal) 244 unit calcium/oxalate normal Negative serologies, normal C3/C4 HG BM negative. ANCA negative

2. »BB 54y male referred for increasing creatinine Dec 2005 HT diagnosed 2005, SBP in 120-140s, recently increasing to 160s DM diagnosed 1/04 with HBA1c of 12.5%, glucose control improved fast, 2/05 HBA1c 6.4%; 11/05 HBA1c 5.8% Microscopic hematuria x few years, renal US normal, cystoscopy negative May 2005Orfila et al Other med hx: remote stones, hypothyroid x 1 yr, no DM complications Meds: glipzide 80 bid, Metformin 500 bid, HCTZ 25 mg, Diovan 160 mg q day, Synthroid 0.75 q day, Norvasc 5 q day, and aspirin 81 mg daily. Serologies negative, 24h U Ca/oxalate normal, U eos neg, ACE normal, imaging normal – renal, retroperitoneaum, hemolysis w/up neg date 1/042/057/0511/0512/812/191/31/61/112/62/23 creat93132125160201210232225285180239 ACR7.31.18.15.349.55 heme1+trace2+

3. IgG- moderate linear GBM staining, common finding in diabetes IgA- moderate to strong mesangial staining IgM- negative C3- moderate mesangial staining,moderate vascular staining C1q- negative Kappa- negative Lambda- negative Fibrin- moderate interstitial staining Albumin- moderate linear GBM and TBM staining, common finding in diabetes IF

4. IgG

5. IgA

6. C3

8. Fibrin

9. Albumin

14. Diagnosis: Renal Biopsy: Diabetic glomerulopathy with superimposed IgA nephropathy