Patient is a 70-year-old female, referred to renal clinic for AKI, and new proteinuria. She had seen her family physician for an annual visit, and had complained of dark urine, mild malaise, and a “head cold”. Over the past several months, she has had some on-and-off symptoms of cold, some nausea, and poor appetite. She had seen GI specialist for that, but the workup was negative. Relates possibly to “breast cancer meds”. She denies any cough, hemoptysis. No fevers, chills, no myalgias, no rashes, no dysuria.
Breast CA: stage I ER+. sp lumpectomy on letrozole
Amlodipine, atorvastatin, carvedilol, hydralazine (started 9 months prior to current presentation), letrozole (had developed arthralgia on anastrozole), losartan, aspirin, vitamin D, iron supplement.
BP: 179/70. Heart Rate: 57. O2 Saturation%: 100. Weight: 181 pounds. BMI: 27.5.
General: Somewhat fatigued appearing otherwise well and NAD. No rash, no edema.
Laboratory and other data:
Baseline serum creatinine 0.8 mg/dl. Now within few days at current presentation: -> 1.4 -> 1.8 -> 2.3
Hb 9.8 mg/dl,
WBC normal, with normal differential, platelets borderline low
Serologies: MPO pANCA>8 (normal<0.4 units), Anti-Histone Ab 1.2 U (normal<1.0 U), ANA 1:640, C3 70 mg/dl (90-180), C4 4 mg/dl (10-40), RF negative, Cryo negative, SPEP/UPEP neg
>Urinary protein to creatinine ratio: 0.6 g/g (urine dip in the past: negative)
Sediment in clinic: Numerous red blood cells, some rare to occasional acanthocytes, no casts.
Renal ultrasound notable for increased cortical echogenicity bilateral, normal-sized kidneys.