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.
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
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.