The risk of HLA DR4 positive. - USMLE Forums
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Old 07-03-2011
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DNA The risk of HLA DR4 positive.

A man who hopes to donate a kidney to a relative with end-stage renal disease is being evaluated for donor compatibility. The evaluation shows that he is HLA DR4 positive.
The man is 47 years old and has no personal or family history of diabetes.
Based on the evaluation results, the physician would most likely conclude that


A. The man will develop diabetes within the decade.
B. Other family members are at risk for diabetes.
C. The man should lose weight to reduce the likelihood of developing diabetes.
D. HLA DR4 and diabetes may not be linked in the manís family.
E. If the recipient is DR4 positive, the likelihood of developing diabetes is certain.
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Old 07-03-2011
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D but i not sure
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Old 07-03-2011
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I'd go with D. they may not be linked in this man's family.
HLA DR4 is associated with Type I DM, so since he's 47 years old it's unlikely he will develop diabetes since he hasn't alreayd.
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Old 07-03-2011
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exactly heights,i agree......
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Old 07-03-2011
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I think its E..
If recipient has a familial predisposition,he can develop DM 1..as they have not mentioned the recipients' age..
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Old 07-03-2011
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Quote:
Originally Posted by struggle View Post
I think its E..
If recipient has a familial predisposition,he can develop DM 1..as they have not mentioned the recipients' age..
If the recipient has a familial predisposition and is going to develop DM, I think he will develop it whether or not he gets a kidney. Plus, in answer E all the recipients organs are already DR4+ so his risk of developing diabetes is independent of the donors risk.
DM I occurs because autoantibodies are made against the pancreas B-islet cell. Getting a transplanted kidney (or lung or whatever) won't suddenly make you start producing antibodies against your own organs.

Edit: I would also rule out E because it says "the likelihood is certain". Almost nothing in medicine is ever certain and since test makers know that they are more likely to use words like "very high probability" for the correct answer.
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Old 07-03-2011
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Correct Answer correct answer

The answer is D.

Recall that the association of HLA DR4 with diabetes is not causal. There may be no linkage with HLA DR4 and diabetes in this family; thus, no conclusions can be drawn for other family members, who may not even have been tested as potential donors (choice B). Although weight loss is generally beneficial for reducing the chance of developing diabetes (choice C), the patient is not identified as at increased risk and cannot be advised that he will develop diabetes within a specific time frame (choice A).
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