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Based on the lab findings in the image, here is a full analysis:
Nephrology Case: Chronic Glomerulonephritis
Lab Values Extracted from the Image
CBC:
- RBC: 3.4×10¹²/L ↓ (anemia)
- Hb: 110 g/L ↓
- Ht: 0.78
- WBC: 8.9×10⁹/L — differential: segs 68%, eos 8%, mono 4%, lym 18%
- ESR: 22 mm/h ↑
- Stab cells 2%
Biochemistry:
- Total protein: 63 g/L ↓ (hypoproteinemia)
- Creatinine: 157 µmol/L ↑
- GFR: 72 mL/min ↓
- Sodium: 121 mmol/L ↓ (hyponatremia)
- Potassium: 3.0 mmol/L ↓ (hypokalemia)
Urine test (dipstick):
- Color: white-yellow
- Transparency: full (turbid)
- Specific gravity: 1.009 (isosthenuria — loss of concentrating ability)
- Protein: 0.99 g/L ↑ (significant proteinuria)
- Leukocytes: 5–6 per field ↑
- Erythrocytes: 7–8, 8–10 per field ↑ (hematuria)
- Hyaline cylinders: 4–6 per field
- Grainy (granular) cylinders: 7–10 per field ↑
Nechiporenko urinalysis (per 1 mL):
- Leukocytes: 2000/mL
- Erythrocytes: 2500/mL ↑
- Cylinders: 100/mL ↑
Diagnosis: Chronic Glomerulonephritis
The combination of findings is classic for chronic GN:
| Finding | Significance |
|---|---|
| Proteinuria (~1 g/L) | Glomerular basement membrane damage |
| Hematuria (erythrocytes 8–10/field, Nechiporenko 2500/mL) | Glomerular origin bleeding |
| Hyaline + granular casts | Tubular stasis from chronic glomerular disease |
| GFR 72 mL/min (CKD Stage G2) | Mild-moderate reduction in filtration |
| Creatinine 157 µmol/L | Impaired renal clearance |
| Isosthenuria (SG 1.009) | Loss of tubular concentrating function |
| Hypoproteinemia (63 g/L) | Urinary protein loss |
| Hyponatremia + hypokalemia | Fluid-electrolyte dysregulation |
| Normocytic anemia (Hb 110) | Chronic kidney disease–related |
According to Henry's Clinical Diagnosis and Management by Laboratory Methods, chronic glomerulonephritis classically produces hematuria + proteinuria macroscopically, with granular and waxy casts, occasional blood casts, erythrocytes, leukocytes, and epithelial casts on microscopy — exactly matching this case.
Harrison's Principles of Internal Medicine (22E) notes: when confronted with an abnormal urinalysis + elevated creatinine, the key question is whether GN is acute or chronic. Here, reduced GFR (72), creatinine elevation, isosthenuria, and granular casts all point to a chronic process.
Likely Subtype to Consider
The 8% eosinophilia is mildly elevated and could hint at a secondary cause (e.g., IgA nephropathy, membranoproliferative GN). Further workup should include:
- Kidney biopsy
- Complement levels (C3, C4)
- ANA, ANCA, anti-GBM antibodies
- Hepatitis B/C serology
- Kidney ultrasound (likely small, echogenic kidneys)
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