1. U06-24697 #32251-4521 Healthy young male 28 Y came in with bilateral flank pain Creat 155 went up to 286 Received solumedrol 1 gm last night Today’s creat in 272 R/O GN

2. 28/M- Caucasian Came in with bilateral flank pain 1-2 days prior to admission. Flank pain started gradually. Not radiating. No Dysuria, No Hematuria, No fever, No Chills, No sore throat and No Hx of Kidney stones. Two-Three days prior to admission patient took 12-14 Advils (?400mg) for “Holiday Induced Headache” over 36-48 hours.

3. PMH: Anxiety: on Citalopram 100 mg/day (for about 4 years). NO Hx of Kidney Disease, HTN, DM Allergy: NKDA

4. Labs on admission: Na, K, Cl, Anion Gap, Hgb, Platelet: NL WBC:7K, Pmn 65%, Lymph 25%, Eosi 1% Creat 155 (baseline Cr: 80-90 mmol/L), Urea 10 mmol/L C-Reactive Protein: 30 mg/L U/S of the Kidney: NL U/A: pH: 5.50, SG: 1.010, Protein: +2, Hgb: +3, WBC 5-10

5. Physical Examination: Vitals: within Normal Limits Lungs: CTA bilateral Skin: No rash (except the flushing of the face) Extremities: No pedal edema.

6. Hospital Course: Crea Increased to 280 despite of IVF therapy. Patient was started on Steroid Pulse Biopsy was scheduled. …..And Biopsy showed…

7. IF IgG- Negative. IgA- Mild mesangial staining. IgM- Trivial to mild mesangial staining. C3- Mild to moderate mesangial staining. Moderate vascular staining. C1q- Negative. Kappa- Negative. Lambda- Mild mesangial staining. Fibrinogen- Moderate interstitial staining. Albumin- Negative.

8. IgA

9. IgM

10. C3

12. Lambda

13. Fibrinogen

14. EM is pending

15. Diagnosis Renal Biopsy: Acute allergic interstitial nephritis with signs of tubular injury. No definitive evidence of primary glomerular disease.