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A 72 year old woman presented to her primary care physician complaining of 1 month of worsening nausea and vomiting. She had a history of sinusitis and rheumatoid arthritis, which she treated with the nonsteroidal anti-inflammatory drug Daypro. Examination revealed mild hypertension. A diagnosis of sinusitis and NSAID-induced gastritis was made. She was advised to discontinue Daypro, and was begun on Capoten 25 mg tid, Amoxil 500mg tid x 10 days and Entex bid.
Five days later she had not improved. Laboratory data were obtained and revealed a serum creatinine of 7.4 mg/dl. She was referred to a regional medical center and admitted for evaluation and treatment.
Physical examination was relatively unremarkable. Laboratory data included: serum creatinine 8.2 mg/dl, BUN 59 mg/dl, glucose 98 mg/dl, calcium 9.0 mg/dl, total protein 6.3 g/dl, albumin 3.7, hematocrit 30.3%, urine protein 319 mg/24hr, 3-4 RBC/HPF and 1 WBC/HPF in the urine, sedimentation rate 85 mm/hr, C3 120 mg/dl, C4 55 mg/dl, negative ANA assay, negative ANCA assay and positive rheumatoid factor assay at 1:10. Renal ultrasound revealed 11 cm and 10.5 cm echogenic kidneys consistent with "medical renal disease". There was no evidence for obstruction.
A renal biopsy was performed.
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