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Nephrology


Answer 1
  1. IgA nephropathy. Isolated hematuria without other manifestations of glomerular disease (eg, proteinuria and systemic symptoms) after an upper respiratory infection is most consistent with IgA nephropathy. Disease states with similar clinical presentations include thin basement membrane disease and Alport’s syndrome. IgA nephropathy may be diagnosed with renal biopsy, but this test is not often needed. Light microscopy shows focal or diffuse mesangial proliferation and immunofluorescence microscopy demonstrates mesangial deposits of IgA. Electron microscopy reveals electron dense deposits in the mesangium but also may show deposition in the subendothelial and subepithelial spaces. The clinical course of IgA nephropathy is often benign in patients with isolated hematuria, but a small percentage of patients with proteinuria and hypertension can progress to end-stage renal disease. Nephrolithiasis typically manifests with flank pain and a stone on urologic imaging. Bladder cancer often occurs in older individuals with a history of carcinogen exposure. Wegener’s granulomatosis is a more fulminant disease, presenting with renal failure, hemoptysis, and sinus symptoms. Postinfectious glomerulonephritis is most commonly associated with streptococcal throat or skin infection. The patient had neither of these problems.

    SUGGESTED READINGS
    1.
     Korbet SM. Percutaneous renal biopsy. Semin Nephrol 2002;22:254-67.

    2. Sutton JM. Evaluation of hematuria in adults. JAMA 1990;263:2475-80.

    3. Topham PS, Harper SJ, Furness PN, et al. Glomerular disease as a cause of isolated microscopic haematuria. Q J Med 1994;87:329-35.

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