Nephrology-2 - laptoping

[ArchivalUser]

A 19-year-old man is evaluated for gross hematuria. Two days ago, he was diagnosed with pharyngitis. A similar episode occurred approximately 1 year ago.

On physical examination, blood pressure is 150/90 mm Hg. The remainder of the examination is normal except for a resolving pharyngitis.

Laboratory Studies
Blood urea nitrogen: 14 mg/dL (5 mmol/L)
Creatinine: 0.9 mg/dL (79.58 μmol/L)
C3: 130 mg/dL (1300 mg/L)
C4: 30 mg/dL (300 mg/L)
Urinalysis: No proteinuria, numerous dysmorphic erythrocytes and 1 erythrocyte cast/hpf

Which of the following is the most likely diagnosis?

A Systemic lupus erythematosus
B Antineutrophil cytoplasmic antibody“associated small-vessel vasculitis
C Postinfectious glomerulonephritis
D Cryoglobulinemic glomerulonephritis
E IgA glomerulonephritis

[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

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This patient most likely has IgA glomerulonephritis. This condition is the most common form of glomerulonephritis worldwide and typically manifests with the nephritic syndrome. IgA glomerulonephritis is associated with dysmorphic erythrocytes and erythrocyte casts and hypertension; this patient's presentation is characterized by normal renal fution. Henoch“Schönlein purpura, an IgA-dominant form of vasculitis, is unlikely in the absence of a rash.

This patient's normal complement levels exclude systemic lupus erythematosus and cryoglobulinemic glomerulonephritis, which both present with low C4 levels and possibly low C3 levels. Compared with IgA glomerulonephritis, these conditions also are less likely to develop in a 19-year-old man. Antineutrophil cytoplasmic antibody“associated small-vessel vasculitis may cause glomerulonephritis alone. However, extrarenal manifestations usually develop in this setting. In addition, this condition more commonly affects older patients, does not develop suddenly, and is not typically associated with a viral pharyngitis.

[ArchivalUser]

also ...uri + GN WITHIN FEW DAYS /WITH URI.......IgA NEPHRO
....URI + GN AFTER FEW WKS OF URI........POST INFEC GN