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DISCUSSION COM- APRIL 2023

CASE OF THE MONTH- MAY 2023

Case Contributed by: Prof. Manoj Jain, SGPGI, Lucknow
CASE HISTORY:

33 year old male

C/O Headache - 3 days ; Blurring of vision - 2 days

Evaluated and detected to have BP of 212/160 mmHg

Fundus examination - multiple haemorrhages and grade IV hypertensive retinopathy

ECG - changes s/o LVH with strain pattern

On Examination:

CNS- Lateral rectus palsy on Lt side

Rest - WNL

Investigations:
Hb- 9.6 gm/dl, TLC- 11.2 x1000/ul, Platelets – 72 x1000/ul.
PBS 4-5% schistocytes, Reticulocytes -3.33 %

S. Creatinine - 6.2 mg%

LDH - 1426 mg%, C3 - 101.0 mg/dl, C4 - 26.6 mg/dl,

Anti-GBM <3.0 u/L , Anti MPO <3.0 u/L , Anti PR3 <3.0 u/L

Urine Examination

Albumin 2+, WBCs 8-10m /HPF , RBCs >100/HPF

USG: Bilateral normal sized kidneys


Syndromic diagnosis: Rapidly progressive renal failure

Kidney Biopsy performed





Direct Immunofluorescence

Negative for IgG, IgM, IgA, C3 & C1q


Diagnosis?

Probable aetiology ?

Further diagnostic workup?


Management ?
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