226757920U06-2835

Lupus.Nephrotic syndrome now. Normal creat.C3/C4, ANA +,? Membranous ?antiphospholipid Ab syndrome

226757920U06-2835

42 Yr Female with diagnosis of SLE On prednisone 7.5mg/d, Hydroxy- chloroqiune 200mg/d for control of Systemic features. Referred for Proteinuria 2 yrs ago. Creatinine 70-80 umol/l. protein 300-500mg/d Last visit edema(new onset) Creatinine 80umol/5grams proteinuria Albumin 28g/L C3  0.58 C4 0.04 ANA+ve, anti DNA 76( baseline 15-30) ENA -ve UA   3+ protein MIC  25-50 WBC's      11-25 RBCs.. HB 113-116 Haptoglobin 3.22 LD 185  FOB -ve           Ferritin 54???? D/D Membranous    Mixed

• IgG- moderate to strong coarsely granular capillary loop staining

• IgA- moderate coarsely granular capillary loop staining• IgM- moderate coarsely granular capillary loop staining• C3- mild to moderate coarsely granular capillary loop

staining/ mild mesangial staining• C1q- mild to moderate coarsely granular capillary loop

staining/ mild mesangial staining• Kappa- inadequate tissue• Lambda- moderate coarsely granular capillary loop

staining• Fibrin- moderate interstitial staining• Albumin- mild hyaline droplet change in tubular

cytoplasm

IF

IgG

IgA

IgM

C3

Clq

Lambda

Fibrin

Albumin

Diagnosis:Renal Biopsy:Lupus nephritis.

(A)Membranous and focal Proliferative Glomerulonephritis Pattern.

(B)Moderate Activity (NIH score 8/24) and Low Chronicity (1/12).