WBR0283
| Author | [[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Renal |
| Prompt | [[Prompt::A 5-year-old boy is brought to the emergency department by his mother because she noticed that his eyes appear swollen when he wakes up in the morning for the past 4 days. The eye swelling tends to resolve over the course of the day. The mother told you that he was stung by a bee two weeks ago, and there was also an outbreak of influenza in his school some few weeks back. He is generally very healthy and there is no family history of any chronic disease. His temperature is 36.7 C (98.0 F), blood pressure is 140/90 mm Hg, pulse is 92/min, and respiratory rate is 17/min. Physical examination is unremarkable. Urinalysis shows oval fat bodies and profound proteinuria. Which of the following findings is needed to make a diagnosis on light microscopy?]] |
| Answer A | AnswerA::Segmental sclerosis and hyalinosis |
| Answer A Explanation | [[AnswerAExp::Incorrect. This is a characteristic finding in focal segmental glomerulosclerosis. This is the commonest glomerular disease in HIV patients, heroin addicts, and sickle cell disease. It is also the commonest cause of nephrotic syndrome in adult.]] |
| Answer B | AnswerB::Diffuse capillary and glomerular basement membrane thickening |
| Answer B Explanation | AnswerBExp::Incorrect. This is a finding observed in membranous glomerulonephritis (diffuse membranous glomerulonephropathy). This is a slowly progressive disease of the kidney affecting mostly patients between ages of 30 and 50 years, usually Caucasians. |
| Answer C | AnswerC::Normal glomeruli |
| Answer C Explanation | AnswerCExp::Correct. The glomeruli in minimal change disease are normal or near normal when examined using a light microscope. Electron microscopy reveals flattening and fusion of the podocyte foot processes in the glomeruli. |
| Answer D | AnswerD::Enlarged, hypercellular glomeruli with a “lumpy-bumpy” appearance |
| Answer D Explanation | [[AnswerDExp::Incorrect. Enlarged, hypercellular glomeruli with a “lumpy-bumpy” appearance on light microscope refer to an acute post-streptococcal glomerulonephritis. Electron microscopy reveals sub epithelial immune complexes. It may present with dark urine, periorbital edema. Acute glomerulonephritis is characterized by the sudden appearance of hematuria, proteinuria, red blood cell casts in the urine, edema, and hypertension with or without oliguria. It can follow streptococcal infections.]] |
| Answer E | AnswerE::“Wire looping” of capillaries |
| Answer E Explanation | AnswerEExp::Incorrect. This is a feature seen in diffuse proliferative glomerulonephrits. This is mostly caused by SLE. |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::The boy in this vignette has nephrotic syndrome. This is a kidney disorder characterized by proteinuria, hypoalbuminemia and edema. Minimal change disease a.k.a Nil disease or lipoid nephrosis is the commonest cause of nephrotic syndrome in very young children. It usually starts with facial edema. It can be triggered by a bee sting, previous upper respiratory tract infections, drugs or malignancies. Treatment is very effective with corticosteroids.
Educational Objective: Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia and edema. Minimal change disease is the commonest cause of NS in children, and it can be effectively treated with steroids. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Nephrotic syndrome, WBRKeyword::minimal change disease |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |