Abstract
A 77-year-old woman was referred with renal impairment—serum creatinine 230 mmol/L (2.61 mg/dL) and proteinuria 2.14 g/day. The past medical history included hypertension, sicca symptoms and osteoarthritis. Her medications included amlodipine 5 mg od, omeprazole 20 mg od and prednisolone 10 mg od. Systematic enquiry revealed lethargy and 6 kg weight loss over 6 months. Examination was unremarkable. Laboratory investigations revealed normocytic normochromic anaemia with reactive thrombocytosis. Serum lactate dehydrogenase was elevated. Bone biochemistry, liver function tests, serum protein electrophoresis, immunoglobulins, anti-nuclear antibodies, anti-neutrophil cytoplasmic antibodies and complements were all negative or normal. Ultrasound showed normal-sized unobstructed kidneys of normal echogenicity.
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