1. Presented by Mark Haas, M.D. and prepared by Carol Allan, M.D.

A 30 year old African-American man presented with pneumococcal septicemia. He was noted to have lower extremity edema and a serum creatinine of 4.7 mg/dL which rose to 7.5 mg/dL 8 days after intravenous antibiotic therapy was started. A 24 hour urine collection showed 22 grams of protein. Serum albumin is low at 1.6 g/dL. Urinalysis showed 3-5 RBCs and 5-10 WBCs per high power field. Hepatitis B and C serologies, ANA, and ANCA are all negative, and serum complement levels are within the normal range. There are no known HIV risk factors.

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