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  #1  
Old 03-18-2012
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Kidney What would the kidney biopsy show?

A 5-year old aferbrile boy has sudden onset of swelling of her face, hands, legs & feet 1 week after a upper respiratory tract infection treated with supportive care. Laboratory studies show:
Serum
Albumin 2.0g/dL
Urea Nitrogen 6.0 mg/dL
Creatinine 0.6 mg/dL
Cholesterol 280 mg/dL
Urine Protein 4+; 6.0 g/24h

What would you see on light microscopy of the patient's biopsy?

A. Segmental sclerosis and hyalinosis
B. Diffuse capillaries and GBM thickening
C. GBM splitting caused by mesangial ingrowth
D. Normal glomeruli
E. Crescent shaped structures in glomeruli

PS- This is not NBME question
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  #2  
Old 03-19-2012
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seems like a classic picture of nephrotic syndrome of minimal change disease histologically..........
1)children>2-6 years old
2)followed by respiratory infection
3)generalized edema
4)hypoalbuminea less than 3gm/dl
5)massive proteinuria
6)hypercholesterolemia
So i think the answer is D)normal glomeruli
which occurs in minimal change disease under light microscpoy.
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  #3  
Old 03-22-2012
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I'll go with

C. GBM splitting caused by mesangial ingrowth

due to the connection with a previous respiratory tract infection
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  #4  
Old 03-22-2012
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i read the first sentence and jumped to option C.
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Old 03-22-2012
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Quote:
Originally Posted by BritneySpears View Post
I'll go with

C. GBM splitting caused by mesangial ingrowth

due to the connection with a previous respiratory tract infection
But thats a nephritic syndrome , this is nephrotic

So its MCD .........D........
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  #6  
Old 03-22-2012
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Normal glomeruli.

It's MCD, you can't see sh... on light microscopy
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Old 03-22-2012
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yea, after reading the rest of the question, D looks more likely since you have proteinuria like mad.
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Old 03-22-2012
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based on urinary protein, this is a nephrotic syndrome & not nephritic syndrome
& minimal change disease can be triggered by infection, so i will go with D
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Old 03-22-2012
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I think this is Post-Streptococcal Glomerulonephritis. For minimal change disease you wouldn't see anything on LM but there would be fusion of podocytes on EM.

IF its PSGN, I would go with B) Diffuse capillaries and GBM thickening. It would thicken the GBM because you would have an infiltration of neutrophils and lymphocytes through the diffuse capillaries.

Is that correct?
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  #10  
Old 03-22-2012
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i would go with D/minimal change disease) - in poststreptococcal , they wouldve atleast mentioned hematuria
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Old 03-22-2012
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Quote:
Originally Posted by Hope2Pass View Post
I think this is Post-Streptococcal Glomerulonephritis. For minimal change disease you wouldn't see anything on LM but there would be fusion of podocytes on EM.

IF its PSGN, I would go with B) Diffuse capillaries and GBM thickening. It would thicken the GBM because you would have an infiltration of neutrophils and lymphocytes through the diffuse capillaries.

Is that correct?
I think it's post-streptococcal too, but I must confess my trouble in distinguishing all these kidney diseases microscopically...
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Old 03-22-2012
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Quote:
Originally Posted by Hope2Pass View Post
I think this is Post-Streptococcal Glomerulonephritis. For minimal change disease you wouldn't see anything on LM but there would be fusion of podocytes on EM.

IF its PSGN, I would go with B) Diffuse capillaries and GBM thickening. It would thicken the GBM because you would have an infiltration of neutrophils and lymphocytes through the diffuse capillaries.

Is that correct?

thats for membranous GN .seen in elderly with inf , CA , drugs ........
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  #13  
Old 03-22-2012
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Idea!

okay- I give up. changing my answer to D.
(did not know there was a link between infections and Minimal change disease)
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Old 03-22-2012
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The trick is 1 week after URI, Ig A nephropathy will occur 1-2 days after URI, poststrepGN 1-2 weeks after URI since it takes time for immune complex to form and ...... TIII HS.

D.
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Old 03-22-2012
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Ah I see.. So this is Minimal change disease then? The upper respiratory infection was just a distractor ? So I guess the answer would be D. Normal Glomeruli coz you dont see any changes on LM ... Right?
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Old 03-22-2012
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Quote:
Originally Posted by Hope2Pass View Post
Ah I see.. So this is Minimal change disease then? The upper respiratory infection was just a distractor ? So I guess the answer would be D. Normal Glomeruli coz you dont see any changes on LM ... Right?
Hmm....but upper respiratory tract infection wasn't a distractor at all as minimal change disease is also preceded by upper respiratory tract infection.......
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  #17  
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Quote:
Originally Posted by Master shifu View Post
Hmm....but upper respiratory tract infection wasn't a distractor at all as minimal change disease is also preceded by upper respiratory tract infection.......
Oh ok...Time to go over some renal pathology!
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Old 03-22-2012
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Quote:
Originally Posted by Master shifu View Post
Hmm....but upper respiratory tract infection wasn't a distractor at all as minimal change disease is also preceded by upper respiratory tract infection.......
I know it was not, I just shared a concept since I saw some posts about poststrep in earlier posts. Thank you.
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  #19  
Old 03-22-2012
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Nephrotic syndrome, with normal glomeruli on light microscopy. I believe the respiratory tract infection is a distractor. .
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  #20  
Old 03-22-2012
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D,.........
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  #21  
Old 03-22-2012
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Quote:
Originally Posted by Keisha View Post
Nephrotic syndrome, with normal glomeruli on light microscopy. I believe the respiratory tract infection is a distractor. .
Not at all a distractor @kesha......mentioned it earlier.....just go through the chart of nephrotic types of glomerular disease depicted in Goljan...u will get it.
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  #22  
Old 06-26-2012
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Bunny ................. plz post the answer............

no point making ppl post their own answer and their own story

unless a question is answered by the questioner (assuming the

questioner knows the answer)
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  #23  
Old 06-27-2012
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nephritic syndrome-urine protein less than 3.5g/day
nephrotic syndrome -urine protein more than 3.5g/24 hours
patients urine protein is 4+,6.0 g/24 hours
so -nephrotic syndrome
minimal change disease -often preceded by respiratory infection or routine immunization (goljan rr 403p,fa 2012-517p),lm-normal glomeryli,em-foot process effacement

answer is normal glomeruli
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