1. U06-7995 #904681210 53 yr old woman with sinusitis,arthritis pulmonary hemorrhage,microscopic hematuria Proteinuria 2.5g/day (+) pANCA,Cr 127 ANA(+). Anti ds-DNA…,complements normal

2. 53 year old woman with microscopic hematuria 2+ proteinuria, HTN,Creatinine 111 (84 in July 05). pANCA positive. She has symptoms of sinusitis for 10 years, inflammation of multiple joints off and on. Feb 28 presented with flu like symptoms such as nasal discharge, cough and body ache treated with antibiotics. March 28 developed hemoptysis. CXR showed perihilar ground glass appearance possibly pulmonary hemorrhage. Bonchoscopy with BAL on April 10 showed hemorrhagic fluid. U06-7995

3. IgG-negative IgA- negative IgM- mild vascular staining C3- trivial punctate mesangial staining,moderate vascular staining C1q-negative Kappa-negative Lambda-negative Fibrin- mild to moderate intestinal staining Albumin- focal hyaline droplet changes in podocyte IF

4. IgM

5. C3

6. Fibrin

7. Albumin

11. Diagnosis: Renal Biopsy: Chronic glomerulonephritis, consistent with a chronic phase of systemic vasculitis. A.no diagnostic immune complex deposition by immunofluorescence or ultrastructure. B.diffuse mesangioproliferative pattern in non-sclerotic glomeruli,with moderate disease activity and focal crescents. C. Moderate to severe parenchymal scarring