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Chapter 13: Pathology of Medical Renal Disease

A 6-year-old boy developed severe swelling around his eyes and ankles. He was seen by his primary care physician who performed a dipstick urinalysis that was very positive for protein in the urine, but negative for blood and leukocytes. The most likely kidney disease causing these symptoms and signs is:

A. Acute postinfectious glomerulonephritis

B. Minimal change disease

C. Anti-GBM glomerulonephritis

D. ANCA glomerulonephritis

E. Diabetic glomerulosclerosis

Answer: B

Explanation: The periorbital and ankle edema along with marked proteinuria and no hematuria is indicative of nephrotic syndrome. Minimal change disease is the most common cause of nephrotic syndrome in young children and thus is the correct answer. Anti-GBM glomerulonephritis and ANCA glomerulonephritis cause hematuria and less proteinuria. Diabetic glomerulosclerosis usually does not develop until an average of 15 years after diagnosis of type I or type II diabetes.

A 21-year-old Caucasian man noticed that every time he had an upper respiratory tract infection, his urine turned tea-colored. He went to his primary care physician who obtained specimens for laboratory tests that showed a normal serum creatinine, normal complement levels, negative assay for antinuclear antibodies, and a urinalysis revealing numerous red blood cells and red blood cell casts in the urine, and low-level proteinuria. The patient underwent a renal biopsy. What diagnostic feature is most likely to be observed?

A. Subepithelial immune deposits indicative of acute postinfectious glomerulonephritis

B. IgA-dominant immune deposits indicative of IgA nephropathy

C. IgG, IgA, IgM, C3, and C1q immune deposits consistent with lupus glomerulonephritis

D. Numerous subepithelial deposits in a membranous nephropathy pattern

E. Focal glomerular scarring with no immune deposits consistent with focal segmental glomerulosclerosis

Answer: B

Explanation: The numerous red blood cells and red blood cell casts in the urine, and low-level proteinuria, indicate the presence of some form of glomerulonephritis. Normal complement levels, and negative assay for antinuclear antibodies, make lupus glomerulonephritis less likely. Membranous nephropathy and focal segmental glomerulosclerosis cause nephrotic syndrome rather than glomerulonephritis. The onset of gross hematuria (tea-colored urine) at the same time as upper respiratory tract infections (synpharyngitic) is a common presentation for IgA nephropathy.

A 10-year-old girl visited a petting zoo with her parents. One week later she developed bloody diarrhea and became lethargic. She developed progressive swelling and reduced urine output. She was taken to a ...

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