Patient is a 30-year-old female who was noted to have increased proteinuria during an outpatient visit with Rheumatology. She has known history of SLE, no prior renal biopsy was done. Patient being controlled on Hydroxychloroquine and Azathioprine. Patient was on Prednisone 40 mg daily for lupus related myositis (elevated CK and Aldolase).
Medical history:
SLE (dx in 2001, ANA +, SSA +)
Myositis
Hx of PE (Lupus Anticoagulant +)
Asthma
Chronic Allergic Rhinitis
Hypertension
Microscopic Hematuria
Medications:
Azathioprine
Diltiazem CD
Fluticasone-Salmeterol inhaler
Hydrochlorothiazide
Hydroxychloroquine
Prednisone 40 mg po daily
Warfarin
Family History:
Multiple family members with SLE
HTN
No known kidney disease
Physical Exam:
T: 99F / 38C, BP: 127/88, HR: 76, RR: 16, SpO2: 99% on RA
Weight: 246lb / 111.6kg
General: NAD, Moderately Obese
Eyes: EOMI, PERRL, No Icterus
ENT: No Ulcers, Dentition normal
Neck: Normal ROM, No Thyromegaly/Lymphadenopathy
CV: RRR, No m/r/g
Lungs: CTAB, No Wheeze
Abdomen: Soft, non-tender, no masses
Neuro: AAO, Strength: UE 5/5, LE: 4/5 Proximal, 5/5 Distal
MSK: No synovitis, Normal ROM all joints w/o effusions
Ext: 1+ Edema, symmetric
Laboratory and other data:
WBC: 12 k/microliter, Hb: 15 mg/dl, Hct: 44 %, Platelets: 250 k/microliter
BUN: 14, serum creatinine: 0.8 mg/dl
Serum albumin: 3.5 g/dl
C3 – 133 (90-180 mg/dL)
C4 – 20 (10-40 mg/dL)
ANA+
dsDNA, SM Ab, HIV, Hep B/C Negative
CK 1356 (26-140 U/L)
SPEP & IFE negative
Serum kappa 10 (3.3-19.4 mg/L); Lambda 9 (5.7 -26.3 mg/L); ratio 1.2 (normal ratio)
Urinalysis:
SG: 1.027, Moderate Small, Protein >300mg/dL, no WBC, RBC: 50-100
>Urinary protein to creatinine ratio: 1.4 g/g
24 Hour Urine Protein: 2.4 gm/day
Renal US: Unremarkable
Short term follow up and additional work up:
Hydroxychloroquinine stopped
Urinary protein to creatinine ratio 0.5 g/g
Plasma globotriaosylsphingosine (lysoGb3) levels normal
Genetic testing negative