Master the board step 3

Nephrology
Henoch-Schönlein Purpura
This presents in an adolescent or child with the following symptoms:
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Raised, nontender, purpuric skin lesions, particularly on the buttocks
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Abdominal pain
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Possible bleeding
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Joint pain
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Renal involvement
Diagnostic Testing
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Best initial test: The presentation of GI, joint, skin, and renal involvement is
the best indicator of Henoch-SchÖnlein purpura.
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Most accurate test: Although a biopsy is the most accurate test, showing
deposition of IgA, it is not necessary.
Treatment
No specific therapy is necessary because Henoch-SchÖnlein purpura resolves
spontaneously over time.
Post-Streptococcal Glomerulonephritis (PSGN)
PSGN results in dark urine, described as “tea colored” or “cola colored.”
Periorbital edema and hypertension also occur. Many other infections can
lead to glomerulonephritis; both throat and skin infections can lead to PSGN.
Diagnostic Testing
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Best initial test: Antistreptolysin O (ASLO), anti-DNase, antihyaluronidase
in blood. Complement levels are low.
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Most accurate test: Although biopsy is the most accurate test, it should not
be done routinely, because the blood tests are most often sufficient. Biopsy
shows subepithelial deposits of IgG and C3.
Treatment
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Penicillin and other antibiotics for the infection should be given, although
they do not clearly reverse the disease.
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Control the hypertension and fluid overload with diuretics.
Cryoglobulinemia
This presents in a patient with a history of hepatitis C with renal involvement.
The patient may have joint pain and purpuric skin lesions.
New oral drugs for
hepatitis C:
• boceprevir
• telaprevir
• simeprevir
• sofosbuvir
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