RayBerg
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A 60-year-old man was diagnosed last year with adenocarcinoma of the lung, and he underwent right lower lobectomy. For the past 3 weeks he has had increasing malaise. On physical examination he has pitting edema to his knees and presacral edema. Abdominal and chest CT scans show scattered hepatic mass lesions and hilar lymphadenopathy. A urinalysis reveals 4+ proteinuria, and his 24 hour urine protein is 2.7 gm. His serum urea nitrogen is 55 mg/dL with creatinine of 6.1 mg/dL. A renal biopsy is performed, and there is focal deposition of IgG and C3 with a granular pattern. Which of the following forms of glomerular disease is he most likely to have?
A Membranous glomerulonephritis
B Rapidly progressive glomerulonephritis
C Nodular glomerulosclerosis
D Goodpasture syndrome
E Membranoproliferative glomerulonephritis, type II
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| silver
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B Rapidly progressive glomerulonephritis
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| new_n_lost
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A Membranous glomerulonephritis
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| keepgoing
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yes a membranous GN..biopsy thickened MB and IgG C3+ve
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| RayBerg
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But membranous is a nephrotic problem and urine protein/24h in the given problem is less than 3.5g.
Also, doesn't membranoproliferative GN Type II also deal w/ C3 nephritogenic +?
Btw..membranous is the right answer.
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| new_n_lost
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Tht was confusing me protein levels were not equal to Nephrotic and none of the other Choices fit the Presentation Except RPGN.
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| new_n_lost
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Btw where is this Q from ??
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| ssrpk
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al the glomerulonephritis which cause nephrotic syndrome don't do that right from the very beginning, so they all start with some proteins in the urine and gradually progresses to develop proteinuria in nephrotic range.
Think of membranous GN when there is malignancy.
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| RayBerg
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RayBerg wrote:
Also, doesn't membranoproliferative GN Type II also deal w/ C3 nephritogenic +?
Can someone expand on this point? What would be the findingsin membranoprolif gn type II?
The question was from webpath.
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| silver
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in type II there are very low C3 levels because the C3 nephritic factor (which is an autoantibody) causes overdrive of C3 convertase by binding to it and is continuously breaking down complement. so that's the reason y it can't be type II.
type II's characteristic finding is diffuse intramembranous deposits and tram tracks.
does webpath give an explanation to this ques.? can you post that?
i chose RPGN because of the level of proteinuria....i was going over the part about the malignancy, but felt RPGN was more closer to the picture.
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| RayBerg
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silver, unfortunately I don't remember what the question # was. Webpath does give an explanation, but its usually a 1 sentence answer so its not very useful in understanding the concept. However, if I run into that question again, I'll definitely post the explanation in a day or 2.
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| epica
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To Silver
RPGN is crescentic, rapid progressive (following Goodpasture, SlE, Wegner, Berger)
lM; Crescent formation on Basement membrane\
If; Variable (may show Ig or complement)
EM; GBM disruptioin
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| afrocaribb
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Ans is membranous- the man has a history of lung cancer which is one of the course, there is an increase in BUN and creatinine but their ratio is is not propotional, ie it is greater that 10:1 so this will remove the option of renal failure ...igG andd C3 with a GRANULAR immunoflour is only found in membranous, crescents are found in RPGN, besides Memb is still the most common type
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| epica
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afrocaribb, good point
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| silver
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epica wrote:
To Silver
RPGN is crescentic, rapid progressive (following Goodpasture, SlE, Wegner, Berger)
lM; Crescent formation on Basement membrane
If; Variable (may show Ig or complement)
EM; GBM disruptioin
yes, i do remember all these points about RPGN, but because of the proteinuria level--since it was in the nephritic range i chose RPGN. but at the same time i did see the point about the malignancy..so that's where it got a bit confusing for me.
i see why it should be membranous glom. not only cuz of malignancy but also the values of BUN and creatinine and, amongst the choices given granular I.F. fits into the membranous picture, not so much in the other choices.
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