Nephro - okt3

[ArchivalUser]

A 21-year-old woman is evaluated for facial and lower-extremity edema of 1 week's duration. For the past 3 weeks, she has had fatigue. She has no history of diabetes mellitus, cigarette smoking, or illicit drug use.

On physical examination, blood pressure is 90/55 mm Hg. Cardiac and pulmonary examinations are normal. There is periorbital edema. The abdomen is soft and without masses. There is 2+ lower-extremity edema.

Laboratory Studies

Creatinine: 0.7 mg/dL (61.89 μmol/L)
Total cholesterol: 325 mg/dL (8.4 mmol/L )
Albumin: 2.9 g/dL (29 g/L)
C3 and C4:Normal

Urinalysis

Specific gravity 1.026, 3+ protein, 0“1 erythrocytes/hpf, numerous oval fat bodies/hpf

24-Hour urinary protein excretion: 15 g/24 h

Which of the following is the most likely diagnosis?

A Minimal change glomerulopathy
B Membranous nephropathy
C Focal segmental glomerulosclerosis
D Membranoproliferative glomerulonephritis
E Systemic lupus erythematosus nephritis

[ArchivalUser]

b..

[ArchivalUser]

any1else!!!!!!!!

[ArchivalUser]

Membranous nephropathy (MN) accounts for 25% to 30% of nephr. s. in adults, with peak in 4. and 5. decades, so maybe AAA?

[ArchivalUser]

isn't A more common with childrenss! bededoktorem

[ArchivalUser]

yes it is but still accounts for 15 - 20 % Nephr. synd in adults

[ArchivalUser]

i think its e

[ArchivalUser]

it could be E too, but only fatique in this patient is characteristic for lupus

[ArchivalUser]

AA b/c of oval fat bodies on urinalysis

[ArchivalUser]

The answer is A

This patient most likely has minimal change glomerulopathy. Minimal change disease is the most common cause of the nephrotic syndrome in children and young adults. A low albumin level in the presence of proteinuria is consistent with this condition. Minimal change disease associated with the nephrotic syndrome presents with edema; hypoalbuminemia; hypercholesterolemia; urinary protein excretion >3.5 g/24 h; and numerous oval fat bodies on urinalysis, which is another hallmark of a proteinuric state.

Membranous nephropathy and focal segmental glomerulosclerosis, also forms of the nephrotic syndrome, should be included in the differential diagnosis. This patient's symptoms are consistent with membranous nephropathy, but this condition typically presents in older individuals and develops less rapidly. Similarly, the development of focal segmental glomeruloslerosis is less drastic compared with this patient's disease course. Membranoproliferative glomerulonephritis is associated with a low C3 level, whereas both the C3 and C4 levels are low in systemic lupus erythematosus. In addition, membranoproliferative glomerulonephritis and systemic lupus erythematosus are unlikely in the absence of hematuria.