Minimal Change Disease

LAB 2: Diseases Affecting Glomeruli - part I See supplemental material posted on Angel

Case 1: A father brings in his 2.5-year-old daughter because she has had puffy eyes for the last two days. A week prior to her presentation she had an upper respiratory tract infection. On exam she is afebrile with a blood pressure of 90/60 mmHg (normal). She has periorbital and ankle edema bilaterally but no rashes or bruising. Her family history is positive only for a paternal grandfather with nephrolithiasis. Questions: 1. What are the potential causes of edema in this girl?

2. What additional information do you need to narrow down the differential diagnosis (e.g., physical exam findings, lab tests, imaging studies)?

3. Is this clinical presentation consistent with nephritic or nephritic syndrome? Why?

4. What would the renal biopsy show and when is a biopsy indicated?

*********************** Case 2: A primary care physician refers a patient to you for consultation. This 50-year-old African-American male is a clinical laboratory scientist working in the IU Health Pathology building at 10th and West streets. He is otherwise healthy except for mild hypertension and new leg edema up to his knees. The edema has not improved with anti-diuretic therapy and salt restriction as previously prescribed by his physician. He began smoking during a 3-year tour in the Navy and now has a 35-pack-year history. There are no known risk factors for HIV, hepatitis B or hepatitis C. His family history is unremarkable except for his father who died of colon cancer at age 60.

Questions: 1. What are the potential causes of edema in this adult male? What is the importance of viral risk factors in a patient with edema?

2. What additional information do you need to narrow down the differential diagnosis (physical exam findings, lab tests, imaging studies)?

3. What clinical syndrome does this clinical presentation represent?

4. What might the renal biopsy show and when is a biopsy indicated?

Case 3: A 27-year-old Biochemistry graduate student from Japan presents with complaints of bloody urine over the past 24 hours. He developed an upper respiratory infection two days ago but is not febrile. The patient also recalls a similar episode about six years prior to this occurrence. His exam is normal except for clear rhinorrhea and a blood pressure of 148/98 mmHg. His family history is negative.

Questions: 1. What are the potential sources for blood in the urine of this patient? How would you differentiate between these possibilities based on the urinalysis?

2. How can you narrow down the differential diagnosis at this stage? What laboratory tests would you order?

3. How would you evaluate the extent of injury to the kidney?

4. What test or procedure would provide definitive information that would assist you in your management of this case?

5. What is the importance of the negative family history for renal diseases?

6. Would you perform a renal biopsy on this patient?

7. If you perform a renal biopsy what would you expect to be the characteristic pathology?