Case 021 -- Renal Insufficiency
PATIENT HISTORY:
The patient is a 65 year old woman with systemic rheumatoid arthritis associated with vasculitis (positive sural nerve biopsy). She developed renal insufficiency with a serum creatinine of 2.0 beginning approximately 9 months ago, presumed to be secondary to vasculitis. She was treated with IV Cytoxan and Solumedrol. Over the past one month, the creatinine has increased to 3.5 mg/dl. The patient has nephrotic syndrome. Blood pressure is 134/86. Medications include antibiotics, steroids, po Cytoxan, and previously low dose coumadin.
LABORATORY DATA:
Creatinine 3.7 mg/dl, BUN 59 mg/dl, urine protein 1.8 gm/24hrs, ANA negative, C3 95, C4 24, urine sediment - inactive (1 WBC/hpf). Kidneys are bilaterally decreased in size by ultrasound.
Contributed by Jianzhou Wang, MD., PhD., Sheldon Bastacky, MD
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