U05-24013#16918344/102

62 year old man with creatinine >800, 3+ proteinuria, 1-2 RBC/hpf, 11-25 WBC/hpf. Has NSAID use.

62 year old man with little or no medical care previously presented withpolyuria and polydipsia, SOB and mild leg edema of 2-3 month duration. Physical exam unremarkable.Creatinine 854, UA 3+ proteinuria, occasional RBCs, U P/Cr 1216 mg/mmol,serology normal. U/S Both kidney 10.3 cm with mildly increased echogenecity

IF• IgG- Moderate diffuse glomerular staining,

predominantly mesangial but with some staining of all glomerular structures

• IgA- negative• IgM- Moderate focal irregular staining of

scarred areas of glomeruli• C3- Same as IgM• C1q- negative• Kappa- Moderate mesangial staining• Lambda- Moderate mesangial staining • Fibrin- Mild to moderate interstitial staining• Albumin- negative

IgG

IgM

C3

Kappa

Lambda

Fibrin

Diagnosis:Renal Biopsy:End-stage Chronic Glomerulopnephritis with features suggesting an immune complex etiology