patho ques - jasmin_dr

[ArchivalUser]

A 55 yr old woman visits her physician for a routine health maintenance examination. On physical examination, her temp is 36.8 C, pulse 70/min, respiration 14/min, and bp 160/105mmhg. Her lungs are clear on auscultation and her heart rate is regular. She feels fine and has had no major medical illness or surgical prodecures during her lifetime. An abd ultrasound scan shows that the left kidney is smaller than the right. A renal angiogram shows a focal stenosis of the left renal artery. Which of the following lab findings is most likely to be present in this pt?

A- Anti-ds DNA titer 1:512
B- C-ANCA titer 1:256
C- Cryoglobulinemia
D- Plasma glucose level 200mg/dl
E- HIV test +ve
F- Plasma renin 15mg/ml/h
G- Serologic test for syphilis +ve

[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

The ans is (F). This is a classic example of a secondary form of hypertension for which the cause can be determined. In this case, renal artery stenosis reduces the glomerular blood flow and pressure in the afferent arteriole, resulting in renin release by JG cells. Renin the activates the renin-angiotensin-aldosterone axis to increase salt and water reabsorption. Anti-ds-DNA is a specific marker for SLE. ANCAs are markers for some forms of vasculitis. Some pts with HBV and HCV may develop mixed cryoglobulinemia with a polyclonal increase of IgG. Renal involvement in such pts is common and may lead to hemorrhages and ulcerations fo the skin. Hyperglycemia is the marker for DM, which accelerates the atherogenic process and can involve the kidneys, promoting the development of hypertension. HIV infection is not related to hypertension. Tertiary syphilis can produce endoaortits and aortic root dilation but HTN is not likely. Good job docs!