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  Thursday, 06 October 2016
  6 Replies
  7K Visits
13 year old male with no past medical history who was referred initially for microhematuria. After evaluation, patient was noted to have proteinuria, non-nephrotic range. UP/C ~1.7. Patient stated he did have gross hematuria associated with URI symptoms. No edema, normal blood pressures, normal serologies, normal serum albumin, negative ANA, negative Hepatitis panel, and both parents negative for hematuria. Biopsy revealed primary membranous glomerulonephritis (positive staining for PLA2R).
Patient was started on Lisinopril with UP/C now 0.7 (however, yesterday ambulatory UP/C 1.3 and first morning UP/C 0.6). Patient no longer with tea color gross hematuria, but remains with glomerular microhematuria.

Not typical presentation. Patient only on Lisinopril.
Question is etiology of glomerular hematuria?

Was there any IgA staining on IF? Also, what are the units of your protein to creatinine ratio?

7 years ago
Negative IgA staining on IF.
UP/C (mg/g Creatinine)
7 years ago
Just to mention that the biopsy showed "remodeling of the basement membrane". When I spoke with the pathologist, she stated that could be the cause of his hematuria. She stained for Alports which was negative.
Seems quite unusual to see gross hematuria with MGN. I have seen IgA co-existing with MGN which would reconcile with the URI symptoms. If it has been transient then perhaps your pathologist is correct.

7 years ago
and lower UT pathology completely excluded..
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