Aashi
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A 25-year-old man presents to the clinic with diarrhea and abdominal pain for one day after eating with his family at a restaurant. He also admits to having generalized aches in his lower extremities for the past several weeks. Two weeks ago, he had an upper respiratory tract infection with coryza and a sore throat, which has subsided. Upon examination, he has a temperature of 100 F, a macular rash on the face, purpuric skin lesions on both the lower extremities and back, and minimal tenderness around both ankles with no soft tissue swelling. Urine analysis shows proteinuria, red cell casts, and hematuria. The stool guaiac is positive. BUN is 43 mg/dL, and creatinine is 3.7 mg/dL. What is the most accurate method of diagnosis?
(A) Skin biopsy
(B) Serum IgA levels
(C) Response to prednisone
(D) Renal biopsy
(E) 24-hour urine
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| prathapdoctor
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the most accurate method of diagnosis will be renal biopsy only.
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| sarika
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is it HSPurpura?
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| webjeee
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why not Skin biopsy
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| MDcooper
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yes renal biopsy.is the diagnosis IgA nephropathy?
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| doc_clotaire
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I also think that the Diagnostic is Henoch -Scholein Purpura witch is another form of Berger disease ( IgA nephropaty ) . HSP not only give you the typical nephritic syndrome ( hematuria , red blood cell cast and proteinuria less than 3 gr )and high BUN and creatinine but also affects the lower extremities like the buttocks and give you athritis , diarrhea , abdominal pain , fever . It is often follows some URI
I think the best initial test may be serum IgA level but the most accurate will be :
d ) Renal biopsy ( even if it 's may not be necessary because there is no specific treatment only in refractory case the patients may need some steroids )
What do you think ?
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| robin082006
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I go with A
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| Aashi
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(D) Renal biopsy
Explanation:
This patient has the classic presentation of abdominal pain, palpable purpura, and arthritis of Henoch-Schönlein purpura (HSP). This disease primarily affects small vessels. The diagnosis is usually made by recognizing the clinical presentation in combination with finding renal involvement on the urinalysis. The disease most commonly occurs in children but occasionally can occur in young adults. Renal biopsy is recommended in this patient because of the presence of proteinuria, red cell casts, and hematuria. Although biopsy diagnosis is usually not necessary, this patient has severe renal damage, and a specific tissue diagnosis is a good idea in the few patients who develop progressive renal insufficiency. Findings may range from focal mesangial proliferation and varying degrees of cellular proliferation to frank crescent formation. Crescent formation needs aggressive management with high-dose corticosteroids. Renal lesions are mediated by IgA autoantibodies against mesangial-cell antigens and are otherwise absent in patients without renal involvement. Most adults do not progress to chronic renal disease or end-stage renal failure. HSP is usually a self-limiting disease, and supportive treatment with NSAIDs can be used for arthralgias and arthritis. High-dose steroids and immunosuppressants, such as cyclophosphamide, can be tried in patients with progressive nephritis. The efficacy of this therapy is not well established.
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