To preserve patient privacy and for didactic purposes, case descriptions and pathology reports have been anonymized and partially fictionalized. The pathology images are representative images from a mixture of similar cases.

Invited Speakers

Michael Germain
Michael GermainCase Presenter | Baystate Medical Center, Springfield, MA, USA | No conflict of interest reported
Michelle Rheault
Michelle RheaultNephrology Discussant | University of Minneapolis, MN, USA | No conflict of interest reported

Case

The patient is a 10-year-old female with a clinical presentation of HSP manifested by joint pain, nephrotic-range proteinuria, hematuria, abdominal pain, and typical skin rash.

Medical history:
None

Medications:
None

Physical Exam:
BP 90/60, showed puffy eyes, puffy ankles, puffy wrists.
The abdomen was benign. Cardiac and lung exams were normal.
Skin showed some mild purpura up to the navel area but not above.

Laboratory and other data:
Visit 1: Creatinine 0.55, HCO3 27
10 days later:  Creatinine 2.1, HCO3 14
Hemoglobin of 11, platelets normal, IgA normal.
Persistently undetectable C4, ANA 1:320, Anti-DNA negative
Urinary protein to creatinine ratio ratio 45 (g/g), +Hematuria and pyuria on UA

Kidney Pathology

Pathology images pending

Membranoproliferative Pattern GN

Immunofluorescence: “Full house”

Electron Microscopy: pending

Questions posed & summary of key discussion points

1. What any additional work may be helpful?
2. How would you treat this patient?

Author(s) of case summary:

Case summary pending

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