L:\usmle review 7 - Sinoe medical homepage.

16. A 65-year-old man develops oliguria and peripheral edema over a period of weeks. Urinalysis
reveals hematuria and proteinuria; examination of the urinary sediment reveals red cell casts.
Radiologic and ultrasound studies fail to demonstrate an obstructive lesion. Renal biopsy shows
many glomerular crescents. This presentation is most suggestive of which of the following
conditions
(A)
(B)
(C)
(D)
(E)
Anti-glomerular basement membrane disease
Diabetic nephropathy
Hypertensive nephropathy
Lupus nephritis
Minimal change disease
16. The correct answer is A. The two principal causes of rapidly progressive glomerulonephritis
are anti-glomerular basement membrane (including both Goodpasture syndrome and isolated
anti-glomerular basement disease) and primary systemic vasculitis (including Wegener
granulomatosis, microscopic polyarteritis, idiopathic rapidly progressive glomerulonephritis,
Churg-Strauss syndrome, polyarteritis nodosa, giant-cell arteritis, and Takayasu arteritis). A very
large variety of other systemic and primary glomerular disease may occasionally cause rapidly
progressive glomerulonephritis, but this is usually not the typical presentation for these diseases.
Diabetic nephropathy (choice B) typically begins with microalbuminuria and hypertension and
progresses over a 10- to 20-year period to renal failure.
Hypertensive nephropathy (choice C) due to essential hypertension typically presents with slowly
rising BUN and creatinine; hypertensive nephropathy due to malignant hypertension presents
with more rapidly rising BUN and creatinine.
Lupus nephritis (choice D) can have many presentations, but the most typical is proteinuria,
which may be severe enough to cause nephrotic syndrome. Also, 90% of cases of systemic lupus
erythematosus occur in women, usually of child-bearing age.