A Case of Rheumatoid Arthritis Presenting with Renal Thrombotic Microangiopathy Probably due to a Combination of Chronic Tacrolimus Arteriolopathy and Severe Hypertension

Table 1

Laboratory data on admission.

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Urinalysis

 Gravity 1.014

 pH 6.0

 Protein 3+

 Glucose (-)

 Occult blood trace

Sediments

 Red blood cell 1-4 /high power field

 Wight blood cell 10-19 /high power field

Urine chemistry

 Protein 245 mg/dL

 Creatinine 60.2 mg/dL

 N-acetyl-β-D-glucosaminidase 12.5 U/L

 β2-microglobulin 40,066 μg/L

Complete blood count

 WBC 15,000 /μL

 Hb 10.6 g/dL

 Platelet 36.8×10⁴/μL

Blood chemistry

 Albumin 2.7 g/dL

 Lactate dehydrogenase 385 IU/L

 Urea nitrogen 46.9 mg/dL

 Creatinine 2.86 mg/dL

 Uric acid 6.9 mg/dL

 Na 139 mEq/L

 K 3.4 mEq/L

 Cl 103 mEq/L

 Ca 6.8 mg/dL

 Pi 1.8 mg/dL

 Estimated GFR 14.7 ml/min/1.73m²

Serology

 HBs antigen 0.1 C.O.I

 HCV antibody 0.1 C.O.I

 IgG 621 mg/dL

 IgA 251 mg/dL

 IgM 152 mg/dL

 CH50 60< U/mL

 C3 110 mg/dL

 C4 30 mg/dL

 C-reactive protein 2.87 mg/dL

 Rheumatoid factor 24.2 U/mL

 MMP-3 413.8 ng/mL

 Antinuclear antibody ×160 speckled

 Anti-DNA antibody 0.6 IU/mL (<9.0)

 Anti-SS-A antibody 89.7 U/ml (<6.0)

 MPO-ANCA 1.0 U/mL (<3.4)

 PR3-ANCA 1.0 U/mL (<3.4)

 Anti-cardiolipin antibody (IgM) <8 U/mL

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GFR; glomerular filtration rate, MMP-3; matrix metalloproteinase-3, MPO-ANCA; myeloperoxidase-anti-neutrophil cytoplasmic antibody, PR3-ANCA; proteinase 3-anti-neutrophil cytoplasmic antibody. The values in the parentheses show the normal range.