Case Study # 1

Iga Nephropathy Patient Returns

Case #1: Iga Nephropathy Patient Returns

    A 46 year old married Caucasian male is admitted to the emergency room because of nausea, sleep problems, fatigue, swelling in the hands and feet, and skin discoloration.  In addition, he suffers from severe oliguria (<400 mL of urine excretion per day).  An examination of the patient’s history reveals that he was diagnosed with Iga Nephropathy (Berger’s Disease) five years ago.  ACE inhibitors were prescribed to lower his blood pressure (in effect reducing the amount of protein in his urine) and he was asked to return periodically for routine check ups on the disease’s progression (however, he never came).  A urinalysis (on a first morning specimen) and a glomerular filtration rate are ordered:

Red blood cells viewed under 400x magnification.	Waxy Cast viewed under 400x magnification.

 1)      Iga Nephropathy is considered

a.     An autoimmune disease

b.     A viral disease

c.     A bacterial disease

d.     A fungal disease

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 2)      What is the significance of waxy casts in this patient’s specimen and does this correlate with his oliguria?

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 3)      Does this patient have end stage renal failure?  Support your answer with urinalysis and GFR data. (hint: Sp. Gravity)

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 4)      The fact that the patient was prescribed ACE inhibitors hints that he was experiencing severe proteinuria.  Speculate why his protein levels are not very high during this stage of the disease?

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 5)      What symptom may have prompted this patient to see his doctor five years ago (when the disease was far less severe)?

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