Background
Case presentation
CBC | |
WBC (4000–8000) | 10,500/μL |
RBC (390–510) | 379 × 104/μL |
Hb (12.0–16.0) | 11.3 g/dL |
PLT (15–35) | 36.9 × 104/μL |
Chemistry | |
TP (6.4–8.0) | 6.4 g/dL |
Alb (3.4–5.0) | 2.8 g/dL |
AST (8–40) | 30 U/L |
ALT (4–43) | 21 U/L |
LDH (106–220) | 345 mg/dL |
BUN (8–20) | 35.6 mg/dL |
Cr (0.5–0.8) | 5.53 mg/dL |
Na (135–147) | 136 mEq/L |
K (3.4–4.9) | 3.9 mEq/L |
Cl (98–108) | 103 mEq/L |
Ca (8.0–10.5) | 7.9 mg/dL |
P (2.7–4.5) | 6.1 mg/dL |
CRP (< 0.02) | 1.16 mg/dL |
Immune-related | |
C3 (86–160) | 145 mg/dL |
C4 (17–45) | 51.3 g/dL |
CH50 (30–45) | 76.8 U/mL |
IgG (380–1620) | 881 mg/dL |
IgA (84–438) | 186 mg/dL |
IgM (57–288) | 33 mg/dL |
ASO (< 166) | 22 IU/mL |
ANA (< 40) | < 40 |
Anti –GBM antibody (< 3.0) | 116 IU/mL |
PR3-ANCA (< 3.5) | <1.0 IU/mL |
MPO-ANCA (< 3.5) | <1.0 IU/mL |
Urinalysis | |
Occult blood | 3+ |
RBCs | >100/HPF |
Protein | 4 + 12.3 g/gCr |
WBC | 1–4/HPF |
Cast | Granular cast(+) |
RBCcast(+) |
First biopsy | Second biopsy | |
---|---|---|
Clinical presentation | CGN | RPGN |
U-P 3.2 g/g·Cr | U-P 12.3 g/g·Cr | |
U-RBC 50–99/HPF | U-RBC > 100/HPF | |
sCr 0.74 mg/dL | sCr 5.5 mg/dL | |
Anti-GBM antibody | Not tested | 116 IU/ml |
Light microscopy | Mesangial proliferative GN | Crescentic GN |
Global sclerosis (1/19) | Global sclerosis (6/31) | |
Fibrocellular crescent (1/19) | Cellular~fibrocellular crecent (18/31) | |
Immunofluorescence | IgA: mes ++ | IgA: mes + |
C3: mes ++ | C3: mes + | |
IgG: mes +, | peripheral linear + | |
peripheral linear ± | IgG: peripheral linear ++ | |
(focal segmental) | (diffuse global) |