Urinalysis revealed 12 red blood cells (RBCs) per high-power field, 4
white blood cells (WBCs) per high-power field, and 0.631 gm/day protein
with albumin (2+). A serum creatinine level of 0.8 mg/dl was reported on
routine laboratory evaluation few months ago. Echocardiography revealed
normal left ventricular ejection fraction (60%), mild concentric left
ventricular hypertrophy and grade I left ventricular diastolic
dysfunction.
Following this she was started on antibiotics, NSAIDS, and
methylprednisolone. As the serum creatinine level did not improve, she
was referred for nephrology consultation. She was planned for kidney
biopsy and was started on cyclophosphamide. Blood transfusion was done.
Renal biopsy revealed necrotizing
and crescentic glomerulonephritis with insignificant glomerular immune
complex deposit suggesting ANCA associated glomerulonephritis in the
view of history of ANCA positivity (Figure 1). She was discharged after
10 days of hospitalization.