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56 year old male

Resident of jammu
Retired army man by occupation

c/c-
Rise in serum creatinine incidentally detected on
routine checkup

History of present illness
History dates back to 3 months when patients
creatinine rose from 0.9(may) to 5.25(sept)
No h/o-
Swelling feet
Decreased urine output
Hematuria,cola colored urine
Fever
Rash
Cough,dyspnoea or hemoptysis
Joint pain,hair loss
Malar rash, photosensitivity
Past history-
No history of diabetes
mellitus,hypertension,asthma,TB
H/O DESI MEDICATION INTAKE FOR WEIGHT
REDUCTION PRESENT(6 MONTHS)


Personal history-
Non smoker
Occasional alcoholic

Family history-
Father died of intracranial hemorrhage 8yrs back.he
had a h/o hypertension

General examination-
Patient is obese
BMI-31.10
BP-130/90mm right arm supine position
PR-76/min
Afebrile
RR-16/min
Mild pallor
No
jaundice
Clubbing
Cyanosis
Pedal edema = +nt
No skin changes
LAP
JVP not raised



CNS-
Higher motor functions within normal limits
Reflexes all present

CVS-
S1 S2 normal
No S3
No murmurs

Resp.system-
Normal vesicular breath sounds
Per abdomen-
Soft
Nontender
No palpable organomegaly
3months back,in may,his creatinine was 0.9
20/8/13

Urea 112
Creatinine 5.73
Na/k/cl 134/6.2/108
Hemoglobin 8.6
TLC 4.5
Platelets 226
Anti gbm IgG antibodies level-23 -ve <12
B 12-18
+ve>18
Urine exam-
Proteinuria-+2
80-100 RBC/hpf
Pus cells-nil
Hemoglobin 9.2
TLC 4.79
UREA 190
CREATININE 7.46
VIRAL MARKERS NONREACTIVE
24HR URINE PROTEINS 7.7GMS/24HOURS
P-ANCA +VE
21/9/13 23/9/13 24/9/13 27/9/13
TLC 4.46 4.4 10.6 13.6
Hb 6.7 6.1 9.2 10.7
Platelets 135 169 46 70
Urea 201 138 127 167
Creatinine 8.25 5.7 5.4 7.00
Na/k 134/5.39 136/5.38 140/4.9 138/4.8
Total bilirubin 0.22
Direct bilirubin 0.09
Calcium 7.3
Phosphate 7.5
Uric acid 8
Urine routine-
Albumin-2+
RBCs-60-70
Pus cells-35-40
Ecg-within normal limits
Chest xray-within normal limits
Ultrasound abdomen
Right kidney-9.6cms
Left kidney-9.2cms
CMD maintained
Fatty liver
Provisional diagnosis-
Rapidly progressive glomerulonephritis
1.Anti GBM disease
2.Double positive disease

RENAL BIOPSY-
Showed 30 glomeruli,22 out of which showed
presence of crescents(9 cellular,7 fibrocellular,6
fibrous in nature)
Few showed partial sclerosis and,partial to total
sclerosis
Tubules showed degenerative changes with tubular
atrophy and compensatory dilitation of the rest
Blood vessels showed thickened vessel wall
Immunoflorescence-
Linear deposits of IgG and weak complement
(C3)along glomerular capillary basement membrane
noted.
Fibrinogen positive in few of the crescents.