Case Histories Renal teaching FRCPATH Part 2 Manchester Case 1: 66-year-old man with chronic kidney disease, persistent haematuria and reduced complement. EM pictures:
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Case 2: 22-year-old female, ACR 124. Previous class IV lupus nephritis. On azathioprine. Now persistent proteinuria.
IgG IMF (Similar with IgA and C9 and C3C)
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EM:
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Case 3: 48-year-old man with nephrotic range proteinuria. Urinary ACR 450. Haematuria. Creatinine 112. Nephrotic syndrome. No diabetes. No hypertension. Immunology pending.
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IgG
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Case 4: 44-year-old man with acute kidney injury. Blood and protein in the urine. High blood pressure. Nephrotic range proteinuria.
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Case 5: 64 year-old female. Rapid deterioration in renal function over the last 6 months. EGFR 20. Nephrotic range proteinuria with ACR at 600. ANA and ANCA negative. C3 high. IMF Negative. EM:
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Case 6: 54-year-old man. Raised blood pressure. Creatinine 174. ACR 581. Immunology screen negative.
Case 7: 60-year-old male. Renal impairment of unclear cores, creatinine 168 with EGFR of 37. Previous history of renal calculi. Refusing nephrolithotomy. Gout on allopurinol. Immunology screen negative.
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IgA IMF
EM.
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Case 8: 30 year old female. Episode of frank haematuria. Rising creatinine. Urine dip 3+ protein, 4+ blood. ACR 651. ANA and ANCA negative.
IgA IMF.
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Case 9: 72-year-old male with nephrotic proteinuria and worsening renal function. EGFR 27. IMF positive for IgG in peripheral capillary loops as well as IgM. IgA shows some positivity in a similar pattern but to a much lesser degree.
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Case 10: 21-year-old male with acute kidney injury. 3+ protein and 3+ of blood. Case 11: 78 year-old with acute kidney injury. 3+ blood and 1+ of protein. PCR 93. Raised calcium on admission. Case 12: 56-year-old male with background of hypertension, treated. CKD with creatinine of 150. One month history of NSAID use and PPI cover. Creatinine has risen to 380. Bland urine. Immunology awaited.
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