Monoclonal antibodies in the diagnosis of renal disease: A preliminary report

Abstract

A 74-year-old, previously healthy woman sought medical advice because of multiple erythematous pustular skin lesions, which had started on her hands and had progressed to her arms, back, abdomen, chest, and legs. The patient had no history of renal dysfunction, renal stones, diabetes mellitus, hypertension, urinary tract infections, or analgesic abuse. She was taking no medications. She had no history of documented hypotension, fever, or chills. The patient denied sore throat, swollen glands, chest pain, shortness of breath, arthritis, and seizures. She had had rheumatic fever when she was a child. Physical examination on admission revealed a blood pressure of 140/ 70 mm Hg; pulse, 80 beats per minute and regular; temperature, 98.6F, and an estimated central venous pressure of 8 cm H20. Numerous pustular lesions, most of which were crusted, were noted on the hands, arms, trunk, buttocks, and soles. No adenopathy was present. The chest was clear. Cardiac examination disclosed an S4, with no S3 or pericardial friction rub. A grade TI/VI blowing diastolic murmur was present at the left sternal border. No opening snap was heard. The abdomen was soft and nontender without evidence of guarding or rebound. The kidneys, liver, and spleen were not palpable. Moderate left costovertebral angle tenderness was present. Rectal and pelvic examinations were unremarkable, The stool was guaiac negative. There was no peripheral edema and no evidence of active synovitis. The patient was alert, oriented, and had full range of motion in a11 extremities; she had no localizing neurologic abnormalities. All reflexes were equal and reactive throughout, with bilateral plantar responses. Laboratory data on admission showed a hematocrit of 39.4%, a white blood cell count of 17,300/mm3 with a normal thiferential, and a sedimentation rate of 90 mm/hr. Sodium was 138 mEq/liter; potassium,