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Pathology

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Kidney

Question
39 out of 60
 

A 7 yrs old girl is brought with complaints of generalised swelling of the body. Urinary examination reveals grade 3 proteinuria and the presence of hyaline and fatty casts. She has no history of hematuria. Which of the following statements about her condition is true? (LQ)



A IgA nephropathy is likely diagnosis

B Her C3 levels will be low

C No IgG deposits or C3 deposition on renal biopsy

D Alport syndrome is likely diagnosis

Ans. C No IgG deposits or C3 deposition on renal biopsy

The clinical symptoms and the findings in the stem of the question (child with generalized swelling because of reduced serum protein secondary to massive proteinuria with urinary lipid casts) are suggestive of nephritic syndrome, The commonest cause in a child of nephritic syndrome is lipoid nephrosis or minimal change disease, So option ‘a’ and ‘d’ are ruled out. Both cause hematuria as a finding.

Electron microscopic examination in minimal change disease show the presence of effacement of foot processes of podocytes.

Summary of salient features of some diseases causing nephritic syndrome.

Glomerular microscopic finding

Disease

Clinical presentation

Light Microscopy

Fluorescence

Electron Microscopy

Membranous

Glomerulopathy

Nephrotic syndrome

Diffuse capillary wall thickening

Granular IgG and C3; diffuse

Subepithelial deposits

Minimal change disease

Nephrotic syndrome

Normal; lipid in tubles

Negative

Loss of foot processes; no deposits

Focal segmental

Glomerulosclersis

Nephrotic syndrome; non-nephrotic proteinuria

Focal and segmental sclerosis and hyalinosis

Focal; Igm and C3

Loss of foot processes; deposits

Membranoproliferative glomerulonephritis (MPGN) Type I

Nephrotic syndrome

Mesangial proliferation; basement membrane thickening; splitting

(I) IgG + C3; C1q + C4

(I) Subendothelial deposits

Kidney Flashcard List

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