Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Nephrology


Answer 3
  1. Emergent renal biopsy. This patient presented with rapid decline in renal function and nephritic sediment, which suggests rapidly progressive glomerulonephritis. Additionally, the pulmonary infiltrates found on this patient’s chest radiograph raise suspicion for a pulmonary-renal syndrome. To confirm the suspected diagnosis, the patient should undergo emergent renal biopsy. Rapidly progressive glomerulonephritis is characterized by crescent formation on light microscopy of the renal biopsy specimen.3 Immunofluorescence microscopy can distinguish between the 3 types of rapidly progressive glomerulonephritis: (1) anti-GBM disease, (2) pauci-immune glomerulonephritis, and (3) immune complex disease. Immune complex disease is associated with low complement levels and is unlikely in this patient given his normal complement levels. Both anti-GBM disease and pauci-immune glomerulonephritis can present as pulmonary-renal syndromes. On serologic testing, anti-GBM antibodies are positive in anti-GBM disease, while ANCA is positive in pauci-immune glomerulonephritis. Although these 2 diseases can be distinguished based on serology, a renal biopsy is still required because many of the currently available assays are not sufficiently accurate and the potential toxicities of current therapies for both diseases are too great to rely on serologic results alone. In anti-GBM disease, immunofluorescence microscopy of the biopsy specimen will show linear deposition of IgG along the basement membrane, whereas immunofluorescence studies are negative in pauci-immune glomerulonephritis.

    REFERENCE
    3.
     Jennette JC. Rapidly progressive crescentic glomerulonephritis. Kidney Int 2003;63:1164–77.

Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 9/22/08 • nvf