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  #1  
Old 03-08-2011
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Urine Sample Renal disease (RBCs in urine)

A male student found to be having erythrocytes in his urine. He denies any history of renal problems or recent illness. Microscopic examination of urine is unremarkable except for rare red cell casts. There is mild proteinuria.

Renal disease (RBCs in urine)-emkid.gif
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What is the diagnosis?

A) diabetic glomerulosclerosis
B) IgA nephropathy
C) lupus nephritis
D) membranous glomerulonephritis
E) poststreptococcal glomerulonephritis
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  #2  
Old 03-08-2011
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It is Lupus Nephritis

You would see Red cell casts b/c of inflammation and nephritic syndrome is due to inflammation, and would get mild proteinuria as apposed to nephrotic where proteinuria is more than 3.5g/day. The subendothelial deposits indicate diffuse proliferative glomerulitis caused by SLE.
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  #3  
Old 03-08-2011
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lupus nephritis.
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Old 03-08-2011
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subendothelial deposits >>>> lupus nephritis
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Old 03-09-2011
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Why not IgA nephropathy?
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because there is no any history of past illness, so there is no any occurence of any infection so igA nephropathy and poststreptococcal glomerulonephritis r excluded
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Old 03-09-2011
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SLE nd male gender ?????
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Old 03-09-2011
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Here the hx z male,renal rbc cast,mild protein uria,sub endothelial deposits ??
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Old 03-09-2011
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Warning! C

Quote:
Originally Posted by Mondoshawan View Post
Why not IgA nephropathy?
however not a typical history of berger that include history of URTI within past 3-5 days followed by active urin sediment mainly hematuria... but it seems most reasonible........!!?
and even incidence...... lupus has predeliction 2 female sex (9:1)
while berge -->more in male........(another +ve point 2 --> B)

HOWEVER histolog finding of subendoth deposits r ccc 2 L.N.

here is a useful site 4 histology of berger

http://www.ndt-educational.org/renalpath.asp
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Qs hints are 4 diffuse proliferative form of lupus neph: ,but sex z stil making it a querry???
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  #11  
Old 03-09-2011
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Quote:
Originally Posted by raheel_memon View Post
Qs hints are 4 diffuse proliferative form of lupus neph: ,but sex z stil making it a querry???
SLE isin't only in females its just predominantly in females.
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Old 03-09-2011
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Quote:
Originally Posted by amresh kumar View Post
because there is no any history of past illness, so there is no any occurence of any infection so igA nephropathy and poststreptococcal glomerulonephritis r excluded
20 % of berger --> no history of URTI
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  #13  
Old 03-09-2011
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Default C

Subendothelial deposits = Lupus (Class III & IV), Membranoproliferative GN

Subepithelial deposits = Post-strep GN, Membranous GN, Lupus (Class V)

Mesangial deposits = IgA nephropathy, Lupus

GBM Thickening = Diabetic Nephropathy, Membranoproliferative GN (duplication of GBM)

Foot Process Effacement = Minimal Change Disease

Glomerular Sclerosis = FSGS


In this question, we are presented with Subendothelial deposits, which limits our answer to C, Lupus, unless there is something here that is supposed to be tricky.

Please correct me if any of the above are incorrect.
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  #14  
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Arrow

Quote:
Originally Posted by apx85 View Post
Subendothelial deposits = Lupus (Class III & IV), Membranoproliferative GN

Subepithelial deposits = Post-strep GN, Membranous GN, Lupus (Class V)

Mesangial deposits = IgA nephropathy, Lupus

GBM Thickening = Diabetic Nephropathy, Membranoproliferative GN (duplication of GBM)

Foot Process Effacement = Minimal Change Disease

Glomerular Sclerosis = FSGS


In this question, we are presented with Subendothelial deposits, which limits our answer to C, Lupus, unless there is something here that is supposed to be tricky.

Please correct me if any of the above are incorrect.
Yes you are correct, and others as well.

This is a qn presented with almost similar scenario except NO protenuria. I took this qn from NBME and made little modifications....

Actual NBME Qn .... Let me put it here :

In a student laboratory session, a male medical student finds erythrocytes in his urine. This finding is confirmed by the hospital laboratory. He denies any history of renal problems or recent illness. Vital signs are within normal limits. Antistreptolysin O titer is less than 1:100. Microscopic examination of urine is unremarkable except for rare red cell casts. There is no proteinuria. The most likely diagnosis is

A) diabetic glomerulosclerosis
B) IgA nephropathy
C) lupus nephritis
D) membranous glomerulonephritis
E) poststreptococcal glomerulonephritis



Correct ans for this qn is B) IgA nephropathy... coz this pt urine test does not detect any proteins. But the scenario described in the qn may confuse students to think b.w IgA nephropathy and Lupus nephropathy. The key word to differentiate these two is NO PROTEIN in the URINE.

I did small changes in the qn to make it to Lupus Nephropathy and I know I'm not an expert to write a perfect qn so I decided to put a diagram that may help you guys to pick the right ans.

Hope you understand the difference. If you want more details, you can look up here...

IgA nephropathy
http://en.wikipedia.org/wiki/IgA_nephropathy#Diagnosis

lupus nephritis
http://emedicine.medscape.com/article/330369-overview
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  #15  
Old 03-09-2011
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Quote:
Originally Posted by aktorque View Post
Yes you are correct, and others as well.

This is a qn presented with almost similar scenario except NO protenuria. I took this qn from NBME and made little modifications....

Actual NBME Qn .... Let me put it here :

In a student laboratory session, a male medical student finds erythrocytes in his urine. This finding is confirmed by the hospital laboratory. He denies any history of renal problems or recent illness. Vital signs are within normal limits. Antistreptolysin O titer is less than 1:100. Microscopic examination of urine is unremarkable except for rare red cell casts. There is no proteinuria. The most likely diagnosis is

A) diabetic glomerulosclerosis
B) IgA nephropathy
C) lupus nephritis
D) membranous glomerulonephritis
E) poststreptococcal glomerulonephritis



Correct ans for this qn is B) IgA nephropathy... coz this pt urine test does not detect any proteins. But the scenario described in the qn may confuse students to think b.w IgA nephropathy and Lupus nephropathy. The key word to differentiate these two is NO PROTEIN in the URINE.

I did small changes in the qn to make it to Lupus Nephropathy and I know I'm not an expert to write a perfect qn so I decided to put a diagram that may help you guys to pick the right ans.

Hope you understand the difference. If you want more details, you can look up here...

IgA nephropathy
http://en.wikipedia.org/wiki/IgA_nephropathy#Diagnosis

lupus nephritis
http://emedicine.medscape.com/article/330369-overview


that is great effort from u ...... thx 4 that
BUT any glomerular ds ...can ve ACTIVE URINARY SEDIMENTS including hematuria , protinuria ,....variably

so BERGER can ve mild degree of protinuria ...even that < nephritic range
......................................isnot that correct..???!
ii also read about that in ur link.... (A smaller proportion (20-30%), usually the older population, have microscopic hematuria and proteinuria (less than 2 gram/day))

i.e take care it couldnt be a differentiating point.... ?!!...but the most cc in ur Q is biobsy finding
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  #16  
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@aktorque

I think the original question was purely testing your knowledge of epidemiology. IgA nephropathy is very common and would be much more likely than Lupus in a young male patient with a nonspecific presentation as in our case. See below:

IgA nephropathy is the most common lesion found to cause primary glomerulonephritis throughout most developed countries of the world [1-7]. Patients may present at any age, but there is a peak incidence in the second and third decades of life. There is approximately a 2:1 male to female predominance in North American and Western European populations, although this difference is not observed among populations in the Pacific Rim.
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  #17  
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Star have a look

Quote:
Originally Posted by apx85 View Post
Subendothelial deposits = Lupus (Class III & IV), Membranoproliferative GN

Subepithelial deposits = Post-strep GN, Membranous GN, Lupus (Class V)

Mesangial deposits = IgA nephropathy, Lupus

GBM Thickening = Diabetic Nephropathy, Membranoproliferative GN (duplication of GBM)

Foot Process Effacement = Minimal Change Disease

Glomerular Sclerosis = FSGS


In this question, we are presented with Subendothelial deposits, which limits our answer to C, Lupus, unless there is something here that is supposed to be tricky.

Please correct me if any of the above are incorrect.
Have a look here ,...that is v good
http://www.ndt-educational.org/renalpath.asp
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Search wire loop lesion

Renal disease (RBCs in urine)-3lupus_l.gif
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Old 03-09-2011
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So what was the answer?

The original question posted by AKtorque is different from the NBME one he posted afterwards.
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Old 03-12-2011
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Save It!

Quote:
Originally Posted by patelMD View Post
So what was the answer?

The original question posted by AKtorque is different from the NBME one he posted afterwards.

original Q ........
lupus
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Old 03-12-2011
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excellent!

So many learning points! This is so commonly asked areas.
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