Characteristics of all forms of glomerulonephritis
- Red blood cells in the urine
- Red cell casts in the urine
- Mild degrees of proteinuria (< 2 g per 24 hours)
- Edema
- May lead to nephrotic syndrome
- Are most accurately diagnosed with kidney biopsy, although this is not always necessary
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7674-7683). . Kindle Edition.
What is the (1) diagnosis, (2) best initial test, (3) most accurate test and (4) Rx of the condition with the following presentation?
- Cough
- Hemoptysis
- Shortness of breath
- Lung findings
- Goodpasture’s syndrome
- Anti-basement membrane antibodies
- Renal biopsy showing “linear deposits”
- Plasmapharesis
What is the (1) diagnosis, (2) best initial test, (3) most accurate test and (4) Rx of the condition with the following presentation?
- Asthma
- Cough
- Eosinophilia
- Renal abnormalities
- Churg-Strauss syndrome
- CBC for eosinophil count
- Biopsy
- Glucocorticoids (prednisolone); add cyclophosphamide if no response to prednisone
What is the (1) diagnosis, (2) best initial test, (3) most accurate test and (4) Rx of the condition with the following presentation?
- Sinusitis and otitis
- Cough
- Hemoptysis
- Abnormal chest findings
- Renal involvement
- Systemic vasculitis that may affect the joint, skin, eye, brain and GI
- Wegener’s granulomatosis
- c-ANCA (antineutrophil cytoplasmic antibodies)
- Biopsy of the kidney
- Cyclophosphamide and steroids
A systemic vasculitis involving every organ of the body except the lung.
List the common presentions of the above condition
- Renal
- Myalgias
- GI bleeding and abdominal pain
- Purpuric skin lesion
- Stroke
- Uveitis
- Neuropathy
- The very nonspecific findings of fever, weight loss, and fatigue will also be present
- Multiple motor and sensory neuropathy with pain are key to diagnosis.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7716-7719). . Kindle Edition.
Polyarteritis nodosa (PAN):
Best initial test
Most accurate test
Other important tests
Rx
ESR and markers of inflammation
Biopsy of the sural nerve or the kidney
Test for HBV and HCV that can be associated with PAN; Angiography showing “beading” can spare the need for biopsy
Cyclophosphamide and steroids
What is the (1) diagnosis, (2) best initial test, (3) most accurate test and (4) Rx of the condition with the following presentation?
- Pianless recurrent hematuria (particularly in an Asian)
- Very recent viral respiratory tract infection
- Proteinuria
- Red cells and RBC casts
- IgA nephropathy (Berger’s Disease)
- No specific blood test. IgA is sometimes elevated
- Renal biopsy is essential
- No proven therapy. Steroids for sudden worsening proteinura; ACE inhibitors if proteinuria exist; Fish oil may delay disease progression
Complement levels are normal
What is the (1) diagnosis, (2) best initial test, (3) most accurate test and (4) Rx of the condition with the following presentation?
- Raised, nontender, purpuric skin lesions, particularly on the buttocks
- Abdominal pain
- Possible bleeding
- Joint pain
- Renal involvement
- Henoch-Schönlein purpura
- The presentation of GI, joint, skin, and renal involvement is the best indicator of Henoch-Schönlein purpura
- Although a biopsy is the most accurate test, showing deposition of IgA, it is not necessary
- No specific therapy is necessary because Henoch-Schönlein purpura resolves spontaneously over time.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7741-7749). . Kindle Edition.
What is the (1) diagnosis, (2) best initial test, (3) most accurate test and (4) Rx of the condition with the following presentation?
- Dark urine (tea-colred, cola-colored)
- Periorbital edema
- HTN
- Hx of sore throat or skin infection
- Post-Streptococcal Glomerulonephritis (PSGN)
- Antistreptolysin O (ASLO), anti-DNase, antihyaluronidase in blood. Complement levels are low
- Although biopsy is the most accurate test, it should not be done routinely, because the blood tests are most often sufficient. Biopsy shows subepithelial deposits of IgG and C3
- Penicillin and other antibiotics for the infection should be given, although they do not clearly reverse the disease. Control the hypertension and fluid overload with diuretics.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7750-7760). . Kindle Edition.
What is the (1) diagnosis, (2) best initial test, (3) most accurate test and (4) Rx of the condition with the following presentation?
- Hx of hepatitis C infection
- Renal involvement
- May have joint pain
- May have purpuric skin lesions
- Cryoglobulinemia
- Serum cryoglobulin component levels (immunoglobulins and light chains, IgM). Complement levels (especially C4) are low.
- Biopsy
- Treat the hepatitis C with interferon and ribavirin.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7761-7768). . Kindle Edition.
True or False:
Drug induced lupus spares the kidney and brain
True
Lupus nephritis:
Best initital test
Most accurate test
Best initial test: ANA (antinuclear antibody) and anti-double-stranded DNA
Most accurate test: Renal biopsy. The biopsy in the case of lupus nephritis is very important. It is not to diagnose the presence of renal involvement but to determine the extent of disease to guide therapy.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7772-7774). . Kindle Edition.
Rx of lupus nephritis
- Sclerosis only: No treatment. This is a “scar” of the kidney
- Mild disease, early stage, nonproliferative: Steroids
- Severe disease, advanced, proliferative: Mycophenolate mofetil and steroids. Mycophenolate is superior to cyclophosphamide
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7776-7782). . Kindle Edition.
CF of Alport’s syndrome.
Rx?
Alport’s syndrome is a congenital problem with eye and ear problems, such as deafness
There is no specific therapy.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7776-7782). . Kindle Edition.
List the triad that make up hemolytic uremic syndrome
- Intravascular hemolysis (fragmented cells on smear)
- Elevated creatinine (ARF)
- Thrombocytopenia
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7783-7794). . Kindle Edition.
What organism is most commonly associated with HUS?
E. coli 0157: H7
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7783-7794). . Kindle Edition.
CF of thrombotic thrombocytopenic purpura (TTP)
- Intravascular hemolysis (fragmented cells on smear)
- Elevated creatinine
- Thrombocytopenia
- Fever
- Neurological abnormalities
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7783-7794). . Kindle Edition.
Rx of HUS and TTP
Treatment is with plasmapheresis in severe cases
- Do not give platelets for hemolytic uremic syndrome or thrombotic thrombocytopenic purpura. They can make HUS and TTP worse
- Also, do not give antibiotics for the infection; doing so may worsen the disease.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7783-7794). . Kindle Edition.
