Nephropathology Specialty Conference

Case #3

The patient is a 54-year-old Caucasian female elementary school teacher who was referred to a nephrologist for evaluation of asymptomatic renal insufficiency, proteinuria, and glycosuria of six years duration.  The patientís past medical and surgical history were unremarkable; specifically she gave no history of pyelonephritis, nephrolithiasis, chronic NSAID use, hypertension, or diabetes mellitus.  Her only medications were Paxil, 20 mg daily for depression and Evista, 60 mg daily for osteoporosis.  Physical examination revealed a healthy appearing woman with BP of 120/80 and no peripheral edema.  Urinalysis revealed 3+ protein, 2+ glucose, 2-4 RBCís/hpf, and 2-4 WBCís/hpf.  Laboratory abnormalities included an elevated serum creatinine of 1.6 mg/dl, depressed uric acid level of 1.3 mg/dl (2.3 ñ6.6 mg/dl), and depressed serum phosphorus level of 2.4 mg/dl (2.6-4.5 mg/dl).  The patient had normal serum levels of glucose (92 mg/dl), chloride (109 mmol/L), calcium (9.7 mg/dl), and albumin (4.2 gm/dl).  Serum cholesterol was mildly elevated at 214 mg/dl and serum bicarbonate was low normal at 23 mEq/L (normal range 22-32).  A complete blood count was unremarkable.  The following serologies were negative or normal: ANA, ANCA, rheumatoid factor, HIV, HbsAg, HCV Ab, ESR and complement levels C3 and C4.  A 24 hour urine collection revealed a creatinine clearance of 54 cc/min and a 24 hour urine protein of 3.105 gm/day.  Renal biopsy was performed.

 

Biopsy Material

LM - 1 slide
IF - 2 prints
EM - 4 prints

Glen S. Markowitz
Columbia University

Click on picture to enlarge

Diagnosis: Light chain mediated Fanconi Syndrome

 

 

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Date this page was last edited: 08/21/00 11:35 AM