IgA_GN-renal_confrence_12-08

IgA_GN-renal_confrence_12-08 - NephrologyRounds...

Info iconThis preview shows pages 1–22. Sign up to view the full content.

View Full Document Right Arrow Icon
    Nephrology Rounds  Riki Buchwald, ID fellow December 17 th  2008
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Case 46 y old AA man with h/o GSW to right trochanter in 8/07, s/p ORIF at OSH Admitted to Bellevue 9/07; found to have wound infection/OM with polyresistant Pseudomonas Extensive debridement performed but hardware left in place Underwent long-term treatment with polymyxin from 10/07 on. Course complicated by renal failure in 11/07 that resolved with polymyxin dose adjustment.
Background image of page 2
Case Hardware removed on 3/12/08 Wound cx with MRSA Received 4 week course of vancomycin and 6 week course of polymyxin after hardware removal; course completed at the end of April
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Case Readmitted in 6/08 with increasing hip pain and persistent drainage Imaging c/w erosion of the right femoral head with joint space loss, septic arthritis and chronic osteomyelitis with sinus tract to the skin surface Debridement and washout performed on 6/18/08: OR cx grew MRSA Treated with vancomycin Developed worsening non oliguric renal failure with creatinine increase from 1.1 on admission to 6.8 mg/dl over 4 weeks
Background image of page 4
Clinical History PMH: - Diabetes, A1c 7.9% in 10/2007 - HTN - Anemia - Remote h/o syphilis, treated SH: no tobacco or drug abuse Meds: insulin, lisinopril, iron, MVI, folic acid, omeprazole, escitalopram, cyclobenzaprine, SQ heparin ROS: several weeks of darkened urine, leg swelling; denied: dysuria, macro-hematuria, SOB, fevers, joint pain, skin rash
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Physical Exam BP 150/89 HR 93 T 97.2 97% RA Middle aged pt, appearing depressed, NAD Sitting in wheelchair Neck supple Lungs: CTA Heart: reg, nl S1 S2 Abdomen: soft, nontender Right thigh with surgical scar, sutures in place, mild swelling and chronic skin changes, no frank drainage Ext: b/l 3+ LE edema
Background image of page 6
Laboratory Data Wbc 11.4, 73% PMN,18% Lymph, Eos WNL Hgb 7.8 Plt 332 Hepatic : 42/64/201/0.2/8.2/3.4 Protein electrophoresis : TP 7.7, albumin 2.4 Globulins: alpha 1, alpha2, beta WNL, gamma 2.6 (0.5-1.3); diffuse bands
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Laboratory Data Creatinine BUN 6/17 1.1 11 6/21 1.5 18 6/30 2.7 36 7/06 3.9 47 7/18 6.8 59 7/30 8.9 64 7/30: K: 5.2, Ca: 8.8, Phos: 6.0 Mg: 2.4 6/24: UA: protein >300 mg/dl, WBC 2-5,RBC packed, fine granular casts, RBC casts 7/02: Urine protein : 2g/day
Background image of page 8
Laboratory Data HIV: negative Hep B : SAb positive, SAg negative Hep C: negative Syphilis: IgG/TPPA positive, RPR negative
Background image of page 9

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Any ideas?
Background image of page 10
A Diagnostic Test was Performed
Background image of page 11

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Normal glomerulus
Background image of page 12
Nodular mesangial sclerosis
Background image of page 13

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Crescentic necrotizing GN
Background image of page 14
RBC casts
Background image of page 15

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
IgA C3
Background image of page 16
Background image of page 17

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Diagnosis Crescentic necrotizing glomerulonephritis with focal mesangial and subepithelial deposits (IgA and C3) Differential diagnosis: - IgA Nephropathy - post infectious GN - pauci-immune ANCA-associated GN - Methicillin-resistant Staphyloccocus post infectious GN
Background image of page 18
IgA nephropathy Postinfectious GN
Background image of page 19

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Laboratory Data C3: 172( 75-140); C4 28.5 (10-34) ASLO: 57 ANA, ds DNA, ANCA: negative Anti-GBM: negative Urine immunofixation: negative
Background image of page 20
Final Diagnosis MRSA- post infectious GN
Background image of page 21

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Image of page 22
This is the end of the preview. Sign up to access the rest of the document.

Page1 / 47

IgA_GN-renal_confrence_12-08 - NephrologyRounds...

This preview shows document pages 1 - 22. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online