45 year old male with eye pain, blurred vision, renal insufficiency and proteinuria

renalfellow1
Published on Dec 11, 2022
CC- 45 year old male with eye pain, blurred vision, renal insufficiency and proteinuria

HPI - A 45 year old previously healthy male presents with 4 month history of fever, anorexia, fatigue, loss of weight, right ocular pain and blurred vision.

EXAM - No edema , No skin rash , No evidence of lymphadenopathy. BP 135/80 mmHg.Rest WNL

Ophthalmologic examination revealed a reduced visual acuity of 20/30 , mild IOP elevation, reduced break-up time (mild xerophthalmia). Slit lamp examination revealed anterior uveitis of the right eye with corneal precipitates (see figure)

LABS
> Hematocrit was 30.1%, hemoglobin 10.4 g/dL, platelet count 330,000/mL,
>CRP high 5.4 mg/dL, ESR high at 95mm/h.
>BUN 75 mg/dL,Cr 4.0 mg/dL HCO3 15 meq/L, Ca 10.9 mg/dL, K 3.4 MEq/L , NA 136, Cl 110 MEq/L
>Urine examination showed pyuria (9-10 white blood cells per HPF) , Glycosuria, proteinuria of 0.7 g/24 h. UC neg
> ANA positive, low c3, normal c4, ANCA negative.
> TSH WNL, BC negative

Renal Biopsy
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Diffuse, severe interstitial inflammation mainly with lymphocytes and plasma cells accompanied by tubulitis.( see figure) Glomerular and vascular structures were preserved apart from a mild intimal fibrosis . Immunofluorescence microscopy showed granular mesangial deposition of C3.

WHICH OF THE FOLLOWING DISEASE IS LEAST LIKELY TO EXPLAIN CLINICAL CONDITION

A. TINU SYNDROME
B. SARCOIDOSIS
C . LUPUS DISEASE
D. SJOGRENS DISEASE

CLICK ON LINK BELOW FOR ANSWER

https://renal.medcase.com/free_cme/45-year-old-male-with-eye-pain-blurred-vision-renal-insufficiency-and-proteinuria/