Kamsi
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A 49-year-old man was well until 1 month ago, when he developed dyspnea, fatigue, decreased appetite, and cough that produces blood-tinged sputum. Three days ago, he had three episodes of frank hemoptysis. He has had no fever or chills. He has a 7-year history of hypertension and has been a smoker for 15 years. He takes no medications.
On examination, the patient is alert and in no distress but is pallid. Blood pressure is 155/88 mm Hg, pulse rate is 90/min, respiratory rate is 18/min, and temperature is 37 °C (98.6 °F). Skin examination is normal. Optic funduscopy shows mild sclerosis and constriction. The carotids and thyroid are normal.
The pharynx is clear. Pulmonary examination reveals coarse crackles in the right mid-lung field. Cardiac examination shows regular sinus rhythm, with no gallop; S1 and S2 are normal.
The abdomen is soft, with no organ enlargement. No redness or swelling of the joints is present.
Laboratory studies:
Leukocyte count 9200/μL
Hemoglobin 8.7 g/dL
Hematocrit 26%
Platelet count 443/μL
Serum creatinine 4.4 mg/dL(was 1 .3 mg/dL 3 months ago)
Serum sodium 142 meq/L
Serum chloride 103 meq/L
Serum potassium 4.8 meq/L
Serum bicarbonate 21 meq/L
Serum total protein 6.3 g/dL
Serum albumin 3.7 g/dL
24-hour urine protein 3.5 g
Urinalysis 4+ proteinuria, 3+ hemoglobinuria
Urine microscopy shows 25 to 50 erythrocytes/hpf, 5 to 15 leukocytes/hpf, dysmorphic erythrocytes, and erythrocyte casts.
Kidney biopsy reveals proliferative glomerulonephritis, with 50% of glomeruli having crescents. Immunofluorescence shows linear staining with IgG
What diagnostic term best describes the disease presentation in this patient?
A. Rapidly progressive glomerulonephritis
B. Nephrotic syndrome
C. Chronic renal failure
D. Acute tubular necrosis
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| dr.wad
Forum Senior
Topics: 3
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A
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| darkhorse
Forum Elite
Topics: 56
Posts: 275
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GPS....50% crescent...dont know wherher gfr is less than 90%...but should be RPGN...aaaaa
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| drdg
Forum Senior
Topics: 31
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AAA
Goodpasture's glomerulonephritis
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| Kamsi
Forum Guru
Topics: 103
Posts: 347
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A
The patient’s renal presentation is rapidly progressive glomerulonephritis which consists of glomerulonephritis with nephritic urine sediment, acute renal failure developing over a few days to weeks, and glomerular crescents on renal biopsy. Nephrotic syndrome is present here but is not usually associated with acute renal failure. The patient has acute renal failure, but acute tubular necrosis would not produce a nephritic sediment.
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| Justice
Forum Fanatic
Topics: 100
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A. Rapidly progressive glomerulonephritis
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