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Old 09-15-2012
venky2600's Avatar
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Question pt. with ATN..?

Q) a 44 yr old male pt. is diagnosed with acute tubular necrosis with glomerular function preserved since a week.his urinalysis analyse proteinuria prior to tubular necrosis of ranges from 2-3.5g/24h ..what is the underlying disease of the pt. that is causing proteinuria..?

a) PSGN
b) minimal change disease
c) Congestive heart failure
d) mcardle's glycogenosis
e) hereditary spherocytosis
f) fanconi syndrome
g) porphyria cutanea tarda
h) i-cell disease
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Old 09-15-2012
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Quote:
Originally Posted by venky2600 View Post
Q) a 44 yr old male pt. is diagnosed with acute tubular necrosis with glomerular function preserved since a week.his urinalysis analyse proteinuria prior to tubular necrosis of ranges from 2-3.5g/24h with hematuria ..his complaitns are fatigue and malaise with no fever...what is the underlying disease of the pt. that is causing proteinuria..?

a) PSGN
b) minimal change disease
c) Congestive heart failure
d) mcardle's glycogenosis
e) hereditary spherocytosis
f) fanconi syndrome
g) porphyria cutanea tarda
h) i-cell disease
added some information
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Old 09-16-2012
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psgn since he is presenting with hematuria and proteinuria which can eventually lead to renal failure
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Old 09-16-2012
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Correct Answer D is right

the most appropriate answer is D) McArdles glycogenosis

here the pt's present condition (ATN) is unnecessary except for a clue of intact glomerular function......so his proteinuria prior to ATN was not glomerular origin for sure

this can exclude-------minimal change and PSGN

in fanconi, CHF------<2g/24h proteinuria

hereditary spherocytosis, PCT ,I cell disease------do not cause proteinuria normally

let's know briefly abt all proteinuria's

1) funtional-------<2gm/24h proteinuria---no renal damage-----ex---excess standing,CHF

2) overflow------variable(from 1-</= to 3.5 g/24 h) proteinuria----cause is excess GFR ,tubule unable to reabsorb efficiently-----------ex---hemoglobinuria's------PNH, mcardle's and also Multiple myeloma
as the GFR increases gradually and tubules unable to reabsorb it, at some time filtered load will disrupt tubular membrane causing necrosis

3) glomerular--------glomerulus funtion is impaired >3.5g/24 hr proteinuria is also seen-----ex---PSGN, minimal change(selective proteinuria of albumins)

4) tubular--------PCT defect to reabsorb <2g/24 hr proteinuria-----ex--Fanconi syndrome,RTA,hartnup disease
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