Nephrology MCQ_Part03

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The most common complication of minimal change disease is:
 1.Infection
 2.Hemorrhage
 3.Side-effects of steroid therapy
 4.End-stage renal disease
 5.Renal vein thrombosis

Primary IgA nephropathy is believed to result from which immunopathogenetic mechanism?

1.Deposition of immune complexes containing IgA1 in mesangium with activation of alternative complement pathway
2.Defective hepatic clearance of immune complexes containing IgA
3.Increased mucosal synthesis of IgA that cross reacts with mesangial antigens
4.monoclonal B cell proliferation producing mesangiopathic IgA
5.planted viral antigens in mesangium inducing an autoimmune response

A 39year old man is complaining of the worst groin pain that he has ever experienced. He feels that he may have strained his groin playing football earlier in the week but notes that the pain seems to begin in the flank. It is affecting his left side and is colicky type and  the pain is worsening on urinating. Dipstick reveals microscopic haematuria. He has no past history of abdominal problems and has had no operations in the past. His observations reveal a heart rate of 120 beats/minute, respiratory rate 24 breaths/minute, sats 92%, blood pressure 157/91mmHg. What is the likely diagnosis?

A. Pyelonephritis
B. Renal calculus
C. Ureteric calculus
D. Renal cell carcinoma
E. Prostatism

MCQ 1 ANSWER

The Correct Answer is C - Minimal change disease


Is a commonest cause of nephrotic syndrome in children in whom this disease occur frequently. Despite massive proteinuria, the renal function remains normal. Over 90% of patients are corticosteroid sensitive while small numbers of patients are corticosteroid dependent or resistant. The later can be treated by immunosuppressive agents. The disease is characterized by normal appearing glomeruli on light and immunofluorescence microscopy and the only abnormality detected is effacement of epithelial cell foot processes which is identified on electron microscopy only. No immune-complexes are identified and so the disease is not an immune complex in origin but several associated features suggests immune mediation. The current hypothesis is that the cell-mediated immunity seems to play an important role where T-lymphocytes are said to produce vascular permeability factor which is responsible for massive proteinuria.

MCQ 2 ANSWER

The Correct Answer is A - IgA NEPHROPATHY


IgA NEPHROPATHY Causes: Nephrotic syndrome
Epidemiology/At risk individuals: Most common type of GN worldwide, occurs 1-2 days after URTI/GIT infections in patients


Clinical features: There is an acquired or genetic defect in regulating production of IgA antibodies. After URTI / GIT infection, too much IgA is produced a forms immune complexes and trapped in mesangium and activate alternate complement pathway a injury. Patient will develop Proteinuria + haematuria (Nephrotic syndrome). Progress to ESRF in 25-50% of patients.


Morphology: Light Microscope: mesangial proliferation, matrix deposition. Immunofluorecence: IgA in mesangium + C3.

MCQ 3 ANSWER

The Correct Answer is C - Ureteric calculus




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Comments

4 comments to "Nephrology MCQ_Part03"

Anonymous said...
May 28, 2010 at 1:13 PM

Ureteric Calculus

Anonymous said...
May 28, 2010 at 4:30 PM

The patient is likely to have fever (tachycardia and tachypnea ).The pain ,which is colicky type, drives to pyelonephtitis as a diagnosis.

Anonymous said...
June 3, 2010 at 6:51 AM

Tachycardia, tachypnea and High Blood pressure its explained with "the worst groin pain that he has ever experienced"
Its Ureteric calculus

Anonymous said...
June 4, 2010 at 6:45 AM

why a ? He have pain, if only genetic ther so rarely to have pain

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