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

Jonathan Slater
Jonathan SlaterCase Presenter | Baystate Medical Center, Springfield, MA, USA | No conflict of interest reported
Eduardo Haddad
Eduardo HaddadNephrology Discussant | Lawrence General Hospital, Lawrence, MA, USA | No conflict of interest reported

Case

Patient is a 25 year old male with history of microscopic hematuria, and episodes of gross hematuria over the past several years, who presents to establish care after long hiatus of medical follow up.

Old records indicate detailed work up for microscopic and macroscopic hematuria, including serologies (all negative), as well as urological evaluation and MRA/MRV. All of which unrevealing.

He has no systemic or focal complaints.

Patient had declined biopsy in the past but now agrees to proceed.

Medical history:
Sports injury (routine athletic activities)

Medications:
None

Physical Exam:
Healthy appearing, normotensive, and athletic.

Laboratory and other data:
Creatinine 7 mg/dl
Urinary protein to creatinine ratio <0.2 g/g

Kidney Pathology

Pathology images pending

Preliminary report: 20% glomerulosclerosis

Few isolated glomeruli show pseudo crescents vs cellular crescents. No focal necrosis. No immune complex deposition

Questions posed & summary of key discussion points

1. Is this a chronic process or acute on chronic process?
2. How aggressive would you be treating this patient given his long standing hematuria with stable renal function?

Author(s) of case summary:

Case summary pending

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