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Pushing Glass (May 16, 2017)

A 15-year-old boy had a kidney biopsy because of the persistent nephrotic syndrome. His medical history is significant for resolved intermittent asthma. In late September 2016, he developed a viral syndrome with a runny nose, congestion, sore throat, vomiting, and diarrhea. Over the next one to two weeks, he developed generalized edema, most prominent in the lower extremities and belly. He was diagnosed presumptively with acute glomerulonephritis and treated accordingly. His condition continued to worsen with the persistent nephrotic syndrome and acute hypertension. Laboratory investigations show a serum creatinine of 1.35 mg/dL. Serum albumin is 1.9 g/dL. Urinalysis shows 3+...

Postpartum HUS

This 22-year-old Caucasian female presented with acute renal failure and proteinuria five days after delivering her first child. The pregnancy was uneventful. Serum creatinine at presentation was 6.2 mg/dL (baseline of 0.8 mg/dL), hemoglobin 2.5 g/dL, platelets 22,000 and LDH 2300 U/L. The biopsy shows glomeruli with endocapillary fibrin thrombi, associated with segmental mesangiolysis and red blood cell fragmentation.  These findings are diagnostic of a thrombotic microangiopathy (TMA).  Numerous etiologies may lead to a TMA, all of which show morphologic overlap with no morphologic finding specific for a single etiology.  Given the clinical history and the timing of disease presentation...