02-24-2008, 03:13 PM
A 42-year-old man is evaluated for a 2-month history of rash on his lower extremities and a 6-month history of cold-induced acral cyanosis and discomfort. He also has a 2-month history of alcohol abuse.
On physical examination, pulse rate is 78/min and blood pressure is 150/90 mm Hg. Cardiac and pulmonary examinations are unremarkable. On abdominal examination, the liver is 3 cm below the right costal margin. A spleen tip is not felt. There is 1+ lower-extremity edema. A purpuric rash also is present on the lower extremities.
Laboratory Studies
Hemoglobin
11.4 g/dL (114 g/L)
Platelet count
120,000/μL (120 × 109/L)
Creatinine
1.7 mg/dL (150.31 μmol/L)
C3
86 mg/dL (860 mg/L)
C4
5 mg/dL (50 mg/L)
Aspartate aminotransferase
57 U/L
Alanine aminotransferase
75 U/L
Urinalysis
3+ hematuria, 1+ protein, 7“10 dysmorphic erythrocytes/hpf
Which of the following is most likely causing this patient's renal abnormalities?
A Systemic lupus erythematosus glomerulonephritis
B Henoch“Schönlein purpura glomerulonephritis
C Cryoglobulinemic glomerulonephritis
D Antineutrophil cytoplasmic antibody“associated small-vessel vasculitis
E Anti“glomerular basement membrane glomeruloneph
On physical examination, pulse rate is 78/min and blood pressure is 150/90 mm Hg. Cardiac and pulmonary examinations are unremarkable. On abdominal examination, the liver is 3 cm below the right costal margin. A spleen tip is not felt. There is 1+ lower-extremity edema. A purpuric rash also is present on the lower extremities.
Laboratory Studies
Hemoglobin
11.4 g/dL (114 g/L)
Platelet count
120,000/μL (120 × 109/L)
Creatinine
1.7 mg/dL (150.31 μmol/L)
C3
86 mg/dL (860 mg/L)
C4
5 mg/dL (50 mg/L)
Aspartate aminotransferase
57 U/L
Alanine aminotransferase
75 U/L
Urinalysis
3+ hematuria, 1+ protein, 7“10 dysmorphic erythrocytes/hpf
Which of the following is most likely causing this patient's renal abnormalities?
A Systemic lupus erythematosus glomerulonephritis
B Henoch“Schönlein purpura glomerulonephritis
C Cryoglobulinemic glomerulonephritis
D Antineutrophil cytoplasmic antibody“associated small-vessel vasculitis
E Anti“glomerular basement membrane glomeruloneph
