11-20-2006, 06:09 PM
A 40-year-old Asian man with a past medical history of diabetes, diagnosed two years ago, and HIV presents to your office complaining of "bloody" urine for 2 days. The patient claims that he has been suffering from a "nasty cold" for the past 2 days. He claims that he has been feeling more fatigued than usual. His medications include zidovudine, didanosine, indinavir, metformin, and lisinopril. He denies tobacco, alcohol, or illicit drug use. On physical examination, vital signs are: temperature 97.9 F; pulse 98/min, and blood pressure 130/80 mm Hg. The heart, lung, and abdominal examinations are normal. There is no edema. Laboratory studies reveal:
White blood cells 6,700/mm3; hematocrit 41%; platelets 410,000/mm3; potassium 4.6 mEq/L; BUN 20 mg/dL; creatinine 1.4 mg/dL; glucose 155 mg/dL; albumin 4.5 g/dL. CD4 count 490; viral load <50 copies. Urinalysis reveals dysmorphic red cells, no white cells or bacteria. There is trace protein and a few red cell casts. Twenty-four hour urine protein 250 mg; C3 normal; C4 normal; ASO negative; serum IgA normal. Electron microscopy reveals mesangial deposits.
What is the most accurate diagnosis of this patient?
(A) Poststreptococcal glomerulonephritis
(B) IgA nephropathy
© HIV nephropathy
(D) Diabetic nephropathy
(E) Minimal change disease
(F) Indinavir-induced renal insufficiency
White blood cells 6,700/mm3; hematocrit 41%; platelets 410,000/mm3; potassium 4.6 mEq/L; BUN 20 mg/dL; creatinine 1.4 mg/dL; glucose 155 mg/dL; albumin 4.5 g/dL. CD4 count 490; viral load <50 copies. Urinalysis reveals dysmorphic red cells, no white cells or bacteria. There is trace protein and a few red cell casts. Twenty-four hour urine protein 250 mg; C3 normal; C4 normal; ASO negative; serum IgA normal. Electron microscopy reveals mesangial deposits.
What is the most accurate diagnosis of this patient?
(A) Poststreptococcal glomerulonephritis
(B) IgA nephropathy
© HIV nephropathy
(D) Diabetic nephropathy
(E) Minimal change disease
(F) Indinavir-induced renal insufficiency