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  #1  
Old 07-18-2011
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Urine Sample Swollen eyes and brown urine

A 12-year-old girl is brought in by her mother, who reports dark brown urine and swelling around the daughter’s eyes. The patient may have complained about a sore throat 2 weeks prior. Which lab result would confirm the suspected diagnosis?
A. Urinalysis positive for protein and red blood cells
B. Serum BUN > 50
C. Serum negative for presence of anti-DNAse B antibodies
D. Elevated serum C3 concentration
E. Serum ASO titer > 1:330
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  #2  
Old 07-18-2011
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D. Elevated c3 enzyme. This girl has post-strep glomerunephritis.
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  #3  
Old 07-18-2011
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Quote:
Originally Posted by mkamal23 View Post
D. Elevated c3 enzyme. This girl has post-strep glomerunephritis.
Elevated serum C3 concentration?...this is a type III Hyper, so C3 should be low...
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  #4  
Old 07-18-2011
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Default Ans.

A. Urinalysis positive for red blood cells and protein
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  #5  
Old 07-18-2011
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I'll go with answer A, Urine Analysis always shows RBC > Elevated
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  #6  
Old 07-18-2011
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Yeah...I think it's A also
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  #7  
Old 07-18-2011
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Answer a
minamal change
common in childern and postinfection
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  #8  
Old 07-18-2011
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e. post strep glomerulonephritis - coca color urine and periorbital edema - 2 week prior pharyngitis from strep
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  #9  
Old 07-18-2011
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I will go for A
c3 level decrease in PSGN
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  #10  
Old 07-18-2011
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sore throat 2 weeks ago.....strep
and the disease is APSGN
SO:
I will go with testing ASO titer

BUT for confirmation I would use the throat swap test for streptococus existence.
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  #11  
Old 07-18-2011
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i guess i would go with e
history is suggestive of post streptococcal G.N.
and aso titre is diagnostic
i guess so
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  #12  
Old 07-18-2011
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Answer d, elevated c3
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  #13  
Old 07-18-2011
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I think its E. Its more specific compared to A. And, for C3 levels they usually go down in poststrep glomerulonephrtis. So, it can't be D.
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  #14  
Old 07-18-2011
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I am with E.
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  #15  
Old 07-18-2011
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periorbital swelling due to sodium retention and hematuria after infection suggests that its PSGN...the best answer is increased anit-DNase B titers....
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  #16  
Old 07-19-2011
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I think its E!
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  #17  
Old 07-19-2011
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i think its e too
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I think its D:
both Post infectious, and IgA nephropathy follow an URTI, and the only distinction between those two is a low C3 level in PIGN.
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  #19  
Old 07-19-2011
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ASO is degraded by the oils in the skin so i assume its not E...
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  #20  
Old 07-19-2011
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dude tell me where did u see this question?
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  #21  
Old 07-19-2011
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E. Serum ASO titer > 1:330
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Learning is like to row your boat upstream, if you stop learning, you will be pushed back by the current.
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  #22  
Old 07-19-2011
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it's E ASO titer.....post strep.GN....
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  #23  
Old 07-19-2011
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E. Serum ASO titer > 1:330
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Correct Answer

The suspected diagnosis is post-streptococcal glomerulonephritis. The dark brown urine suggests hematuria, and the periorbital edema suggests loss of protein. The history of pharyngitis and patient age point toward streptococcal cause, rather than one of the many other causes of hematuria and proteinuria.

In the setting of a recent Group A strep infection, ASO titers (> 1:330), anti-DNAse B antibodies, and anti-hyaluronidase antibodies are frequently elevated. While UA will definitely show proteinuria and red cells, this confirms glomerulonephritis but not the specific entity. Serum C3 concentrations are usually decreased in the setting of PSGN.
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  #25  
Old 07-19-2011
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test aso titre
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  #26  
Old 07-19-2011
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Default E

e for strept.coccus
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  #27  
Old 07-19-2011
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This is a VERY common boards question, and one which you must be able to reason your way through. So this girl has dark brown urine, most likely due to blood (already you could rule out all causes of nephrotic syndrome, e.g. minimal change disease which would present with massive amounts of protein in the possibly foamy urine) and swelling around the eyes (this hints that the kidneys themselves are dysfunctional and that the blood is not from somewhere lower down the urinary tract). The patient may have complained about a sore throat two weeks prior, think about what can cause upper throat pain and lead to blood in the urine. I can think of two easy ones right off the bat. Post-streptococcal glomerulonephritis, and IgA nephropathy post URI. IgA nephropathy is less likely because it typically presents with gross hematuria (sudden, very red urine) and does not cause any edema until much later in the course. This leaves us with PSGN (for which this description is CLASSIC)

On the boards, diagnosis is rarely enough. You see in this question the pattern that will manifest itself over and over again. They describe a clinical scenario and ask you not for the disease, but for features of the disease. See how this is a two step process? We already walked through the first step (diagnosing) above, now lets reason our way through the answer choices:

A. Urinalysis positive for protein and red blood cells, this would confirm that the girl has nephritic syndrome, but this is not a diagnosis. There are many causes of nephritic syndrome, and this question asks for the test that will confirm the diagnosis, i.e. what's CAUSING the nephritic syndrome in this patient.

B. Serum BUN > 50, again this just tells us that her kidneys are in bad shape. It is very non-specific and doesn't give a diagnosis.

C. Serum negative for presence of anti-DNAse B antibodies, DNAse B is a substance produced by Group A streptococci, which are the bacteria responsible for PSGN. If this is indeed PSGN, then the patient must have been exposed to DNAse B and thus one would expect that the serum would have been POSITIVE for anti-DNAse B antibodies. I think a much harder way to ask this question would be to have this answer choice be "Serum positive for presence of DNAse B." This would have still been a wrong answer. Interestingly, as is hinted at by the question stem above, PSGN develops a number of weeks after the infection has been cleared because it is an autoimmune condition. There is not an infection level of Group A strep present during PSGN.

D. Elevated serum C3 concentration, PSGN develops when antibodies directed against Group A strep form immune complexes and deposit in the kidneys. One VERY important fact to remember about immune complexes is that they activate complement! Thus, if this patient has PSGN, immune complexes will activate complement, leading to complement deposition, which causes further damage to the kidneys. When complement is activated, the components are proteolytically cleaved, thus their serum levels should be DECREASED.

E. Serum ASO titer > 1:330, ASO titer is a test for antibodies against steptolysin O, an antigen present on Group A strep. Thus, if this is positive then that means that the patient has experienced a Group A strep infection and this would confirm the diagnosis of PSGN.
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  #28  
Old 07-20-2011
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Default how do i check my answer??

i think E which would rule in PSGN
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  #29  
Old 07-20-2011
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Quote:
Originally Posted by ricko335 View Post
The suspected diagnosis is post-streptococcal glomerulonephritis. The dark brown urine suggests hematuria, and the periorbital edema suggests loss of protein. The history of pharyngitis and patient age point toward streptococcal cause, rather than one of the many other causes of hematuria and proteinuria.

In the setting of a recent Group A strep infection, ASO titers (> 1:330), anti-DNAse B antibodies, and anti-hyaluronidase antibodies are frequently elevated. While UA will definitely show proteinuria and red cells, this confirms glomerulonephritis but not the specific entity. Serum C3 concentrations are usually decreased in the setting of PSGN.
I am confused, so E is not the ans? elevated c3 is the ans? here u are saying that C3 will be decreased, but dec C3 is not even in the options... instead inc c3 is the option?
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  #30  
Old 07-20-2011
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What is the correct
Answer?
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  #31  
Old 08-02-2011
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Quote:
Originally Posted by ricko335 View Post
A 12-year-old girl is brought in by her mother, who reports dark brown urine and swelling around the daughter’s eyes. The patient may have complained about a sore throat 2 weeks prior. Which lab result would confirm the suspected diagnosis?
A. Urinalysis positive for protein and red blood cells
B. Serum BUN > 50
C. Serum negative for presence of anti-DNAse B antibodies
D. Elevated serum C3 concentration
E. Serum ASO titer > 1:330
What is the answer?
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  #32  
Old 08-03-2011
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the answer is e
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  #33  
Old 08-03-2011
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Quote:
Originally Posted by ricko335 View Post
the answer is e
Goljan page#402 , ASO degraded by oil in the skin and is not increased

Whats your source
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