Glomerulonefrites Flashcards

Question 1

Q

Homem de 28 anos, vem ao médico por um quadro de 2 dias de duranção de hematúria intermitente. Não tem disúria nem dor abdominal. Não houve alterações na quantidade de urina ou frequência das micções. Tem rinorreia, tosse seca e odinofagia há 4 dias. Sem antecedentes ou medicação habitual. Atualmente está com temperatura de 38.1°C, FC 70/min, FR 14/min e TA 140/80 mm Hg.
Sem alterações no exame objetivo cardiopulmonar e abdominal. Dor bilateral nos flancos à palpação.
Lab: Leucócitos 11,200/mm3; Urea nitrogen 10 mg/dL; Cr 1.5 mg/dL; Complemento C3 111 mg/dL (N = 80–160)
Urina: Sangue 3+; Proteinas 2+; RBC 12/hpf with dysmorphic features; RBC casts numerous.
Sem alterações na ecografia renal. Qual é o diagnóstico mais provável?
A) S. Goodpasture.
B) Doença de lesões mínimas.
C) Nefropatia de IgA.
D) Glomerulonefrite pós-estreptocócica.
E) S. de Alport.

Answer

A

C) Nefropatia de IgA.

IgA nephropathy most commonly manifests during the second or third decade of life with recurrent episodes of gross hematuria, flank pain, low-grade fever, and/or nephritic syndrome, usually during or immediately following (within days) an upper respiratory tract infection. Between these episodes, patients typically have asymptomatic urinary abnormalities, such as microhematuria. The most likely etiology of these findings is an increased number of defective circulating IgA antibodies, the synthesis of which is triggered by mucosal infections (e.g., pharyngitis). These IgA antibodies form immune complexes that deposit in the mesangium of the renal glomerulus, leading to glomerulonephritis (type III hypersensitivity reaction). A renal biopsy provides a definitive diagnosis but is usually only indicated if there are signs of severe or progressive disease (e.g., proteinuria > 0.5–1 g/24 h, hypertension, elevated creatinine levels).

Question 2

Q

A 22-year-old man comes to the emergency department because of a 1-week history of dyspnea and hemoptysis. He has no known sick contacts. There is no personal or family history of serious illness. He takes no medications. His temperature is 37.0°C (98.6°F), pulse is 82/min, respirations are 22/min, and blood pressure is 152/90 mm Hg. Examination shows inspiratory crackles at both lung bases. The remainder of the examination shows no abnormalities. His hemoglobin is 14.2 g/dL, leukocyte count is 10,300/mm3, and platelet count is 205,000/mm3. Urinalysis shows a proteinuria of 2+, 70 RBC/hpf, and 1–2 WBC/hpf. Chest x-ray shows pulmonary infiltrates. Further evaluation is most likely to show an increase in which of the following laboratory values?
A) Anti-GBM antibody titers.
B) Anti-phospholipase A2 receptor antibody titers.
C) Serum IgA titers.
D) c-ANCA titers.
E) p-ANCA titers.
F) Anti-dsDNA antibody titers.

Answer

A

A) Anti-GBM antibody titers.

Nephritic syndrome (e.g., microscopic hematuria, hypertension, mild proteinuria) and signs of alveolar hemorrhage (e.g., hemoptysis, dyspnea, pulmonary infiltrates) are consistent with pulmonary-renal syndrome. The absence of features of systemic vasculitis suggests that the underlying cause is Goodpasture syndrome.

Question 3

Q

Criança, S.nefrótico, complemento normal. Pensar em?

Answer

A

Doença de lesões mínimas.

Question 4

Q

Glomerulonefrite associada a hiperfiltração.

Answer

A