1. U05-11480 #009N3585833 Recurrent edema with most recent episode proteinuria with creat > 300

2. DOB:26 Jan 1981 25 yo Caucasian female. Medical History: 1.Normal renal function with Baseline Cr of 56 and bland U/A 2001 2.Possible Pyelonephritis 6 years ago – hospital admission and antibiotic 3.Obese – BMI 35 kg/m 2 4.Smoker 5.Bronchitis X 1 6.Depression 7.Remote Cocaine/crack. No IVDU. HBV/HCV/HIV negative

3. Acute Renal Failure June 2005. Two day history bilateral flank pain and urinary hesitancy. Initial renal work-up: Cr 182 and Urine +3 protein, trace hgb, no leuks, 10 WBC. Culture negative but did receive IV Cefotaxime 2 hour before urine collection. No ptn/cr urine at presentation but PAD 3 ptn/Cr 27.45 mg/mol. Immunologic investigations in June unremarkable: neg- ANA, neg-ds-DNA and neg-ANCA (weakly), normal C3, C4. Normal kidney ultrasound. HCV/HCV/HIV negative Subsequent investigations: 08/2005 Cr 79 and U/A normal. 09/2005 U/A 2+ ptn, 4+ blood, 1+leuks. Renal Biopsy post-presentation day 5 (June 10 2005)

4. Referred Sept 2006 for subjective bilateral flank pain daily and pedal edema. Creatinine 60. Urine neg for ptn/hgb. No ptn/cr. Normal liver enzymes and function, and normal TSH. History unremarkable for pulmonary symptoms, those suggestive of chronic suppurative process, connective tissue disease or an auto-immune condition except parathesias and pre-syncopal episodes (non- witnessed). No objective findings confirming deficit in power, tone or DTRs. Neurology to see in October

5. IF IgG- Negative. IgA- Trivial to mild mesangial staining. IgM- Moderate mesangial staining. C3- Trivial to mild mesangial staining. C1q- Negative. Kappa- Negative. Lambda- Negative. Fibrin- Mild interstitial staining. Albumin- Negative.

6. IgA

7. IgM

8. C3

9. Fibrin

13. Diagnosis Renal Biopsy: Focal glomerular sclerosis with relatively mild changes by light microscopy.