The patient is a 42 year old male with a 3 month history of abdominal pain and hematuria. He presented to his physician with pale skin and weakness.

BP 140/72, RR 20, T 37.2, Saturation 95% on 2 liters by nasal cannula and 86% on room air.

Physical Exam:

Cardiac: Normal

Chest: diffuse fine crackles with no wheezes or rhonchi

Abdomen: mid epigastric tenderness

BUN 68, serum creatinine 6.4, hemoglobin 4.8 gm/dL, hematocrit 14.1%, potassium 5.9.

c-ANCA 1:160, P-ANCA 1:512, anti-GBM negative

Renal biopsy showed pauciimmune crescentic glomerulonephritis.

	H&E stain of glomerulus with crescent
	PAS stain of glomerulus with crescent
	Interstitial inflammation of the kidney

1. What is your differential diagnosis?

2. What concerns do you have for the patient's pulmonary status?

3. What would you do for the patient now?