USCAP EVENING RENAL PATHOLOGY SPECIALY CONFERENCE
ATLANTA
Wednesday March 7, 2001
Moderator V. D'Agati

Case 4
Kim Solez, M.D.,
University of Alberta

Clinical Presentation. PI: A 54-yr old female renal allograft recipient. Her primary renal disease was glomerulonephritis of unknown type. She received a cadaveric renal transplant on February 26, 1969 (31 years ago!) at the Toronto Western Hospital. The primary immunosuppressive medications were Prednisone, Imuran100 mg/d. The course after operation was uneventful and her Cr. came down early. Then she was followed in Montreal until 1990 when she moved to Edmonton. Renal function was excellent (Cr. 1.1 mg/dl) until Aug 1997 and Medications were Prednisone 5 mg/d, Imuran 100 mg/d, Hydrochlorothiazide 25 mg/d, (Secteral 150 mg since 96), Premarin, Flurazepam (Dalmane, Ativan). Then because of mild ‚Cr. (1.5), ‚BP to 150/100, Tx ultrasound was normal but scan showed mild functional impairment. She¹s had a UTI in October 1997 treated with Naroxan 3 month Septra Prophylaxis. Again small ‚Cr. to 1.7 ‚BP to 160/108 on May 1997 (start Norvasc 5mg/d). Also she is got Hyper Cholestrolemia 6.35, LDL 3.73 and treated with Bromaline (Herbal Medication). Tx Scan in 98 showed normal perfusion but further functional impairment. D/C Premarine on 99 for better control of BP. ØImurane to 75mg/d for BM toxicity. But BP continued to be high. And on Jan 2000 BP=190/110, Cr. 2.4. Kidney Bx was done 15 Jun 2000. PMH: Hysterectomy in 1990. Hx of Squamous cell Carcinoma. Arms shoulders and legs treated with liquid nitrogen &5FU ointment and surgical excision. Electero-cautery and Laser for persistent Verruca Vulgaris on hands. She had frequent recurrences up to the present. Keratoacanthoma in 99. Hx of Severe Degenerative Disc Disease (L5-S1) on July 93, Sacral (S2)Fracture.

Date Creatinine BP BP Medications Immunosuppressive Other Medications
25JUN86 0.9 110/70 HCTZ 25mg Pred 5mg, AZT 100mg
20JAN93 1.1 130/90 HCTZ 25mg Pred 5mg, AZT 100mg Flurazepam, Liquid N2, 5FU Oint, Premarine
13OCT93 1.3 120/80 HCTZ 25mg Pred 5mg, AZT 100mg Flurazepam, Liquid N2, 5FU Oint, Premarine
30JAN97 1.6 160/102 HCTZ25mg, Secretal Pred 5mg, AZT 100mg Flurazepam, Liquid N2, 5FU Oint, Premarine
17NOV97 1.7 150/90 HCTZ25mg, Secretal, Norvasc 5mg Pred 5mg, AZT 100mg Flurazepam, Liquid N2, 5FU Oint, Premarine
11FEB98 1.9 152/88 HCTZ25mg, Secretal, Norvasc 5mg Pred 5mg, AZT 100mg Flurazepam, Liquid N2, 5FU Oint, Premarine
10AUG99 2.1 "" "" Fluazepam, Liquid N2, 5FU Oint, D/C Premarine
6JAN00 2.4 190/110 "" "" ""
15JUN00 2.3 "" "" ""

Materials Submitted: 3-PASM, 1-Trichrome, 3-PAS, 1-Fibrin, 1-IgM, 1-C4d, 4-EM