Abnormal Urinalysis (GN) Flashcards
A 21 year old male presents to the emergency department with hemoptysis. He is an active smoker. Past medical history is unremarkable and he is on no medications. He has a 3 week history of fatigue, progressive SOB, and oliguria. In the ER his sats are 85% on RA, 90% on LPM, BP is 180/100, Cr 1500 (one year ago it was 70). He has bilateral diffuse crackles in the lungs. His urine dip is positive for blood and protein. What disease do you think this patient has?
A) Streptococcal pneumonia with Post-Infectious Glomerulonephritis
B) Anti-GBM or Goodpasture’s Syndrome
C) ANCA Vasculitis
D) Lung cancer from smoking
Anti-GBM or Goodpasture’s Syndrome
Goodpasture’s Disease:
- Ab against type IV collagen present in lungs and GBM
- More common in 3rd and 6th decades of life, males slightly more affected than females
- Pulmonary hemorrhage more common in smokers and males
- Treat with plasma exchange, cyclophosphamide, prednisone
What is the classic finding on renal biopsy for anti-GBM disease?
a) crescentic GN with a “full house” on immunofluorescence
b) crescentic GN with linear IgG staining on the basement membranes
c) crescentic GN with “pauci” immune deposits
d) crescentic GN with linear IgA staining the basement membranes
b) crescentic GN with linear IgG staining on the basement membranes
A 44 year old male presents to his family doctor. He has been feeling generally unwell for the last 6 months and complains of weight loss, arthralgia, and frequent sinus infections with epistaxis. He was treated for a pneumonia with antibiotics twice in the last month. He presents with hemoptysis to the ER. He is oliguric. Sats at 85% on RA, 95% on 3L PM, BP 160/100, Cr 483 (was 65 one year ago). Urine dips positive for blood and protein. What disease does this patient most likely have?
a) Streptococcal pneumonia with Post-Infectious Glomerulonephritis
b) Anti-GBM or Goodpasture’s Syndrome
c) Granulomatous Polyangitits (ANCA)
d) AIN due to antibiotics with CHF
c) GPA ANCA
A 44 year old male has been feeling unwell for 10 days. He was previously well but busy at work. He is complaining of fevers, pleuritic chest pain, cough, and sputum. His GP diagnosed him with pneumonia and had started him on Levofloxacin. He initially improved but then became tired and oliguric. On presentation to the ER his Cr is 250 and a urine dip is positive for blood and protein. What disease is most likely causing this patient’s nephritic syndrome?
a) Post-Infectious Glomerulonephritis
b) ANCA
c) IgA Nephropathy
d) Lupus
a)PIGN
What biopsy finding is highly suggestive of PIGN?
a) IgA dominant immunofluorescence
b) Pauci immune immunofluorescence
c) sub-epithelial “hump” on electron microscopy
d) sclerotic glomeruli
c) sub-epithelial “hump” on electron microscopy
A 33 F of Japanese descent referred with episodic gross hematuria. She is otherwise well and on no medications. However, she recently had an URTI and developed gross hematuria for 2 days duration 1 day after the URTI started. This has happened three times before. BP 148/92, Cr 121, GFR 58 (was 62 last year), urine dip positive for blood and protein, UTPCR 1800mg/day of protein. What renal disease does this patient most likely have?
a) PIGN
b) IgA nephropathy
c) Lupus nephritis
d) Hep C associated GN
b) IgA nephropathy
Which description is most suggestive of IgA nephropathy?
a) endothelial and mesangial proliferation with non-specific IF and sub-epithelial humps on EM
b) endothelial proliferation with a “full house” on IF
c) crescentic pauci-immune GN
d) endothelial and mesangial proliferation with dominant IgA on IF
d) endothelial and mesangial proliferation with dominant IgA on IF
A 20 M had an episode of nephrotic syndrome at the age of 13 which was treated with steroids and had completely resolved until now. He has been referred with recurrent rapid onset of edema, anasarca. BP 128/89, Cr 60, Albumin 18, urine dip positive for protein, UTPCR shows 10 g/day. What is the most likely cause of this patient’s nephrotic syndrome?
a) diabetes
b) minimal change disease
c) FSGS
d) membranous GN
b) minimal change disease
Which biopsy best describes a patient with minimal change disease?
a) occasional focally sclerotic glomerulus with complete podocyte effacement on EM
b) completely normal glomeruli with complete podocyte effacement
c) thickening of the GBM with epi-membranous spikes
d) Kimmelsteil-wilson nodules
b) completely normal glomeruli with complete podocyte effacement
Which of the following best describes the appearance of primary FSGS on biopsy?
a) thickened GBM with eli-membranous spikes
b) focal sclerotic glomeruli with completely effaced podocytes
c) Kimmelsteil-Wilson nodules
d) Normal light microscopy
b) focal sclerotic glomeruli with completely effaced podocytes
What is the classic finding for membranous GN on biopsy?
a) epi-membranous GBM spikes
b) complete podocyte effacement
c) Kimmelstein-wilson nodules
d) normal light microscopy
a) epi-membranous GBM spikes
What feature is pathognomic of Diabetic Nephropathy?
a) Kimmelstiel-Wilson nodules
b) normal light microscopy
c) epi-membranous GBM spikes
d) podocyte effacement
a) Kimmelstiel-Wilson Nodules
What type of urine is described below? 4+protein, trace blood on dipstick. Negative for glucose, ketones, leukocytes. Sediment revealed 1+ oval fat bodies, 1+ granular fatty casts. 0-2 dysmorphic RBCs per high powered field. a) benign (bland) sediment b) active sediment c) post-renal
Benign (Bland) Sediment:
- 0 or few RBCs, RBCs dysmorphic
- 0 or few RBC casts
- 0 or few inflammatory cells
What type of urine is described below? 2+ protein, 4+ blood on dipstick. Negative for glucose, ketones, leukocytes. Sediment revealed many dysmorphic RBCs, WBC and tubular epithelial cells. Red and white cellular casts were also seen. a) benign sediment b) active sediment c) post-renal
Active Urine Sediment:
+++RBCs and dysmorphic
+++++RBC casts
+++++inflammatory cells and WBC casts
MAID for Minimal Change Disease
MCD M = Lymphoma A = SLE I = Hep C, HIV D = NSAIDs
