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  #1  
Old 06-11-2012
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Urine Sample URI and Diarrhea and Red cell cast in urine

A 25-year-old man presents to the clinic with diarrhea and abdominal pain for one day after eating with his family at a
restaurant. He also admits to having generalized aches in his lower extremities for the past several weeks. Two weeks ago, he had an upper respiratory tract infection with coryza and a sore throat, which has subsided. Upon examination, he has a temperature of 100 F, a macular rash on the face, purpuric skin lesions on both the lower extremities and back, and minimal tenderness around both ankles with no soft tissue swelling.
Urine analysis shows proteinuria, red cell casts, and hematuria. The stool guaiac is positive. BUN is 43 mg/dL, and creatinine is 3.7 mg/dL.
What is the most accurate method of diagnosis?

(A) Skin biopsy
(B) Serum IgA levels
(C) Response to prednisone
(D) Renal biopsy
(E) 24-hour urine

what is your most likely dx?
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Old 06-11-2012
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GN?

Id guess Renal Biopsy..
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Old 06-11-2012
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Quote:
Originally Posted by tyagee View Post
A 25-year-old man presents to the clinic with diarrhea and
abdominal pain for one day after eating with his family at a
restaurant. He also admits to having generalized aches in his
lower extremities for the past several weeks. Two weeks ago, he
had an upper respiratory tract infection with coryza and a sore
throat, which has subsided. Upon examination, he has a
temperature of 100 F, a macular rash on the face, purpuric skin
lesions on both the lower extremities and back
, and minimal
tenderness around both ankles with no soft tissue swelling.
Urine analysis shows proteinuria, red cell casts, and hematuria.
The stool guaiac is positive. BUN is 43 mg/dL, and creatinine is
3.7 mg/dL. What is the most accurate method of diagnosis?
(A) Skin biopsy
(B) Serum IgA levels
(C) Response to prednisone
(D) Renal biopsy
(E) 24-hour urine

what is your most likely dx?
(A) Skin biopsy

Looks like HSP.
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  #4  
Old 06-11-2012
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Quote:
Originally Posted by tyagee View Post
A 25-year-old man presents to the clinic with diarrhea and abdominal pain for one day after eating with his family at a
restaurant. He also admits to having generalized aches in his lower extremities for the past several weeks. Two weeks ago, he had an upper respiratory tract infection with coryza and a sore throat, which has subsided. Upon examination, he has a temperature of 100 F, a macular rash on the face, purpuric skin lesions on both the lower extremities and back, and minimal tenderness around both ankles with no soft tissue swelling.
Urine analysis shows proteinuria, red cell casts, and hematuria. The stool guaiac is positive. BUN is 43 mg/dL, and creatinine is 3.7 mg/dL.
What is the most accurate method of diagnosis?

(A) Skin biopsy
(B) Serum IgA levels
(C) Response to prednisone
(D) Renal biopsy
(E) 24-hour urine

what is your most likely dx?
Seems like a clinical picture of IgA glomerulopathy e.g. Berger's disease. I would recommend as most accurate method to diagnose this option (D) Renal biopsy
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Old 06-12-2012
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Quote:
Originally Posted by Master shifu View Post
Seems like a clinical picture of IgA glomerulopathy e.g. Berger's disease. I would recommend as most accurate method to diagnose this option (D) Renal biopsy
In IgA nephropathy the hematuria usually starts within a day or two of a non-specific upper respiratory tract infection

Quote:
IgA nephropathy is the most common glomerulonephritis throughout the world [1] Primary IgA nephropathy is characterized by deposition of the IgA antibody in the glomerulus. There are other diseases associated with glomerular IgA deposits, the most common being Henoch-Schönlein purpura (HSP), which is considered by many to be a systemic form of IgA nephropathy. HSP presents with a characteristic purpuric skin rash, arthritis, and abdominal pain and occurs more commonly in young adults (16-35 yrs old).
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ans is renal biopsy !
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Quote:
Originally Posted by tyagee View Post
ans is renal biopsy !
What's the diagnosis & explanation ?
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dx is HSP !
expln...basically says, go for renal bx in HSP when there is severe dz.
Quote:
Although biopsy diagnosis is usually not
necessary, this patient has severe renal damage, and a specific tissue
diagnosis is a good idea in the few patients who develop progressive renal
insufficiency.
btw, if q comes with HSP and creatinine is normal with no\minimal proteinuria, is there need for renal bx? i dont think so even though it is GN.
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Quote:
Originally Posted by tyagee View Post
dx is HSP !
expln...basically says, go for renal bx in HSP when there is severe dz.


btw, if q comes with HSP and creatinine is normal with no\minimal proteinuria, is there need for renal bx? i dont think so even though it is GN.
In that case you should do skin biopsy to confirm the diagnosis.
The reason I chose skin biopsy over renal biopsy is that the renal biopsy can have serious complications but skin biopsy won't and it will give you the diagnosis.
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Originally Posted by Novobiocin View Post
In that case you should do skin biopsy to confirm the diagnosis.
The reason I chose skin biopsy over renal biopsy is that the renal biopsy can have serious complications but skin biopsy won't and it will give you the diagnosis.
that concept was for PAN because it has aneurysms in renal artery. does it hold good for HUS?
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