A Case of Dual Positive Glomerulonephritis with Plasma Cell Dyscrasia

A 64-year old female with a history of a pulmonary embolism on rivaroxaban, breast cancer (mastectomy in 2013), hypertension, and diabetes presented for fatigue for one month. She had intermittent hemoptysis for six months. She was brought to the emergency department complaining of fatigue. Blood pressure was elevated to 165/75 mmHg. On exam, she appeared lethargic with pale conjunctiva and leg edema. She did not have a skin rash. Laboratory studies were significant for creatinine of 15.3 mg/dL, blood urine nitrogen 140 mg/dL, potassium 6.5 mEq/L.