A 25-year-old man is brought to the physician because of fatigue, lethargy, and lower leg swelling for 2 weeks. He also noticed that his urine appeared darker than usual and for the last 2 days he has passed only small amounts of urine. His temperature is 37.5°C (98.6°F), pulse is 88/min, respirations are 15/min, and blood pressure is 154/98 mm Hg. Examination shows 2+ pretibial edema bilaterally. Laboratory studies show: Hemoglobin 10.9 g/dL Leukocyte count 8200/mm3 Platelet count 220,000/mm3 Serum Na+ 137 mEq/L Cl- 102 mEq/L K+ 4.8 mEq/L HCO3- 22 mEq/L Glucose 85 mg/dL Urea nitrogen 34 mg/dL Creatinine 1.4 mg/dL Urine Blood 2+ Protein 3+ Glucose negative RBC 10–12/HPF with dysmorphic features RBC casts numerous Renal biopsy specimen shows a crescent formation in the glomeruli with extracapillary cell proliferation. Which of the following is the most appropriate next step in management?
AAdminister methylprednisolone
BAdminister lisinopril
CAdminister cyclosporine A
DPerform hemodialysis
EAdminister rituximab
A 6-year-old boy presents to your office with hematuria. Two weeks ago the patient had symptoms of a sore throat and fever. Although physical exam is unremarkable, laboratory results show a decreased serum C3 level and an elevated anti-DNAse B titer. Which of the following would you most expect to see on renal biopsy?
AImmune complex deposits with a "spike and dome" appearance on electron microscopy
BLarge, hypercellular glomeruli on light microscopy
CWirelooping and hyaline thrombi on light microscopy
DPolyclonal IgA deposition on immunofluorescence
EAntibodies to GBM resulting in a linear immunofluorescence pattern
A 12-year-old girl is presented to the office by her mother with complaints of cola-colored urine and mild facial puffiness that began 5 days ago. According to her mother, she had a sore throat 3 weeks ago. Her immunization records are up to date. The mother denies fever and any change in bowel habits. The vital signs include blood pressure 138/78 mm Hg, pulse 88/min, temperature 36.8°C (98.2°F), and respiratory rate 11/min. On physical examination, there is pitting edema of the upper and lower extremities bilaterally. An oropharyngeal examination is normal. Urinalysis shows the following results: pH 6.2 Color dark brown Red blood cell (RBC) count 18–20/HPF White blood cell (WBC) count 3–4/HPF Protein 1+ Cast RBC casts Glucose absent Crystal none Ketone absent Nitrite absent 24 h urine protein excretion 0.6 g HPF: high-power field Which of the following would best describe the light microscopy findings in this case?
ASegmental sclerosis and hyalinosis
BWire looping of capillaries
CMesangial proliferation
DHypercellular and enlarged glomeruli
ECrescentic proliferation consisting of glomerular parietal cells, macrophage, and fibrin
+ 7 more in the PDF
Browse all chapters