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11 yo Asian female c/o facial puffiness and generalized edema. work up revealed serum albumin 2.2 mg/dl, Cr 0.9 mg/dl, viral screen shows HBsAg +ve, HBeAg +ve, anti-HBsAg Antibodies -ve, anti-HC antibodies -ve, U/A shows +4 proteinuria and microscopic hematuria. which of the following is the most likely diagnosis?
1-Minimal change disease
3-Focal segmental glomerulosclerosis
5-Diffuse proliferative glomerulonephritis
6- IgA nephropathy
On Feb 07, 2011 - 10:24 AM, Misrati responded:
Hey Misrati, I knew this for Step 1 but I forgot. Do you want to make a picture mnemonic? You're good with pictures What do you say?
On Feb 07, 2011 - 10:23 AM, Misrati responded:
Got it buddy, I'll sometime
2-Membranous glomerulonephritis (MGN)
On Feb 07, 2011 - 10:25 AM, Misrati responded:
Hi there.....this is what i know:
first thing: this kid has obviously some kind of a kidney problem; on what informations they give us, most likely the problem is glomerulonephritis.....the problem is: is it nephrotic or nephritic syndrome? based on the quantity of protein excreted in the urine and a very low blood in the urine, most likely this is nephrotic syndrome.....based only on this concept, at least half of the answers could be eliminated......
next: if we agree that this is nephrotic syndrome, look then at patient age....for the exam this is quite critical because, like in this scenario, they might not give you a bunch of details.....so we all should know which are the most likely causes of nephrotic syndrome in kids and adults(of course this rule has some exceptions and this case is one of them)
kids: most common cause of nephrotic syndrome is minimal change disease
adults: most common cause of nephrotic syndrome is focal segmental glomerulosclerosis(FSGN) and membranous glomerulonephritis(MGN); some sources say this 2 causes are equal in procentages, some say FSGN has a slight advantages;
exceptions: not matter what the age is, if the patient has some kind of characteristics, this rule does not apply anymore:
HIV, heroin abuser and afroamerican patient: most common cause of nephrotic syndrome is FSGN
Hepatitis B patient: most common cause of nephrotic syndrome is MGN.....this kid even though he has 11 years and at his age he should have minimal change disease as the most common cause of nephrotic syndrome, because he has hepatitis B, most common cause of nephrotic syndrome here is MGN(answer 2)
this is the explanation for this scenario....hopefully it will help you.....good luck!
On Feb 07, 2011 - 10:21 AM, Misrati responded:
well said, very true
appreciate the explanation
awesome explanation. I need to re-study this topic, too many membranes confuse me. Thanks.
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