Interpretation of the renal biopsy

Latonya J. Hickson, Lynn D. Cornell

Research output: Chapter in Book/Report/Conference proceedingChapter


An 84-year-old female with a history of hypertension presents to the emergency department complaining of shortness of breath. On exam, blood pressure is 180/90 mmHg. Cardiac exam is normal, breath sounds are diminished in both lung bases, and +2 pitting edema is present. Chest X-ray reveals bilateral pleural effusions, and she is hospitalized for suspected acute congestive heart failure. Serum creatinine is elevated to 1.8-1.9 mg/dL from 1.2 mg/dL measured 5 months previously. A urinalysis shows 9.9 g of total protein excretion per day, 31-40 red blood cells per high power field of which greater than 25 % were dysmorphic, 11-20 white blood cells per high power field, lipiduria, and granular casts. Nephrology is consulted. Renal ultrasound demonstrates normal sized kidneys, patent renal veins, and no evidence of hydronephrosis. Initial serologic studies are negative including antinuclear antibody, erythrocyte sedimentation rate, C-reactive protein, antibodies to hepatitis B and C viruses, anti-neutrophil cytoplasmic antibodies (ANCA), and anti-glomerular basement membrane (GBM) antibody titers. C3 is normal, and C4 is mildly reduced at 11 mg/dL (normal 14-40 mg/dL). No monoclonal protein is detected by serum or urine protein electrophoresis studies. To determine the diagnosis, a renal biopsy is recommended.

Original languageEnglish (US)
Title of host publicationClinical Decisions in Nephrology, Hypertension and Kidney Transplantation
PublisherSpringer New York
Number of pages7
ISBN (Electronic)9781461444541
ISBN (Print)1461444535, 9781461444534
StatePublished - Nov 1 2013

ASJC Scopus subject areas

  • General Medicine


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