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RENAL UNIT CASE 4 |
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Clinical History: A 17-year-old Caucasian male is referred to a physician because the urinalysis done during the course of a school physical examination showed red blood cells in the urine sediment. A careful history brought out the fact that he had often noticed "marked, smoky or brownish" urine, especially after exercise or when he had colds. However, he denied nocturia, dysuria, frequency and flank pain. An uncle had died of an undiagnosed kidney disease and his grandfather died of diabetes. Otherwise the history and systems review were noncontributory. On PE the BP was 110/65 mm Hg and there were no abnormalities of the skin. Head, ears, eyes, nose, chest, abdomen and genitalia were all normal. There were no abdominal bruits, no costovertebral angle tenderness. Neurological examination was normal. The hematocrit was 42%. The urinalysis showed trace protein and 50 RBC per high power microscope field. Serum creatinine was 1.0 mg/dl. Questions: 1. How would you characterize the clinical findings in this case of glomerular disease? What are the possible sources of blood in the urine? 2. How would you try to determine where the blood is coming from? 3. What could be accomplished by doing a kidney biopsy? 4. Figure 1 and Figure 2 show the kidney biopsy in this case. Sixty-five percent of the glomeruli were like the one in Figure 1; 35% like the one in Figure 2. What is the morphological diagnosis? 5. Immunofluorescence in the glomeruli:
Electron microscopy: (Figure 4). Where are the electron dense deposits? 6. Can you make a clinical pathological diagnosis? 7. What is the diagnosis? 8. In what other diseases is there prominent deposition of IgA in the glomeruli? 9. How would you summarize this glomerular disease? |
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