q>>>>>>>>>>1 - dep

[ArchivalUser]

A 30-year-old man is seen for evaluation of nephrotic syndrome. He is not diabetic or hypertensive. He is a former user of injectable drugs ( "skin popper"). He denies arthralgia, rash, or hematuria. His blood pressure is 100/60 mm Hg. On examination, the patient has anasarca, and a large, palpable liver. Multiple old skin ulcers are noted on both lower extremities.Laboratory analysis shows:

Creatinine 1.6 mg/dL
Potassium 3.7 mEq/L
Urea nitrogen 20 mg/dL

A 24-hour urine contains 12 grams of protein with no casts. A renal ultrasound reveals echogenic kidneys, each measuring about 13 cm. An HIV test is negative. Which of the following is the most likely diagnosis?
A. AIDS nephropathy
B. Amyloid nephropathy
C. Heroin nephropathy
D. Minimal change disease
E. Poststreptococcal glomerulonephritis

[ArchivalUser]

B. Amyloid nephropathy

[ArchivalUser]

no casts rules out E, HIV is -ve,. He is showing classic nephrtoic symptoms, so I think its Focal segmental Glomerusclerosis due to Heroin. So C??

[ArchivalUser]

BB

[ArchivalUser]

on second thought.....looking at his age....and massive proteinuria + heptasplenomegaly, I think its Amyloid nephropathy. C is a distractor

[ArchivalUser]

yes ans is B

[ArchivalUser]

IVDA......secondary amyloidosis (?due to chronic infection...?HCV).......HSM+big kidneys+NS

AIDS and Heroin can present with FSG.........glomerulosclerosis......thus smaller kidney rather than enlarged........of course liver, spleen wud also be normal in them