Nephrotic & Nephritic Diseases

A 30-year-old heroin user with a history of intravenous drug use has been referred due to an abnormal urinalysis showing proteinuria. He has developed bilateral lower limb swelling, with tests revealing a creatinine level of 3.4 and a 24-hour urinary protein of 4.8g. Hepatitis and HIV tests were negative. What is the likely cause of his renal disease?

An 11-year-old boy developed swelling in both lower limbs and has noticed puffiness around his eyes for the past few days. A urine dipstick shows 4+ proteinuria, and a 24-hour urine protein is 4g/day. What is the diagnosis?

A 50-year-old male with a history of hepatitis C presented with poorly controlled hypertension despite dual antihypertensive therapy and has had pedal edema for the past 10 days. Laboratory tests revealed the following:

• Urea: 75 mg/dL
• Serum creatinine: 3.1 mg/dL
• Urinalysis: 3+ blood and 3+ protein, no pus cells.

What is the most likely diagnosis?

A 28-year-old man, following a recent upper respiratory tract viral infection, presented with two days of visible blood in his urine. Lab results showed normal urea and creatinine levels, with urinalysis revealing 4+ blood and trace protein. What is the most probable diagnosis?

A patient with anasarca has been diagnosed with glomerulonephritis. Renal vein thrombosis is a potential complication. Which type of glomerulonephritis carries the highest risk for this complication?

A 10-year-old girl has developed periorbital swelling followed by lower limb edema. investigations showed 

• creatinine: 1.0 mg/dl
• S albumin: 2
• Urine R/E: Proteinuria 4+, no blood detected

What is the next best step in management?

A 32-year-old teacher presented with nephrotic syndrome and underwent a renal biopsy, which showed a thickened basement membrane, sub-epithelial spikes, and granular deposits of IgG and C3 complement. What is the most likely diagnosis?

A 36-year-old male presented with frothy urine and pedal edema for the past three weeks. Laboratory results showed:
• Serum creatinine: 3.9 mg/dL
• Serum urea: 140 mg/dL
• Serum potassium (K): 4.5 mmol/L
• Serum bicarbonate (HCO3): 16 mmol/L
• Urinalysis: protein (+++) and blood (+++)
What is the most appropriate management for this patient?

A 50-year-old male presented with periorbital swelling, pedal edema, and a blood pressure of 150/100 mmHg. Laboratory results showed:

• Serum creatinine: 1.7 mg/dL
• Serum urea: 65 mg/dL
• Urinalysis: proteinuria (+++), hematuria (++)
• Renal biopsy: mesangial and subendothelial deposits
• Immunofluorescence: irregular capillary wall deposits positive for IgM and C3

What is the most likely diagnosis in this case?

A patient developed anasarca and significant proteinuria, with investigations revealing normal serum complement levels. What type of glomerulonephritis could this indicate?

Glomerulonephritis is suspected in the patient. What findings are expected on urinalysis?

A 30-year-old male, who started penicillamine therapy after experiencing hand tremors and upper limb rigidity, now presents with pedal edema and periorbital swelling. A 24-hour urine test shows protein excretion of 5.5 grams. What is the most likely cause of nephrotoxicity in this patient?

A patient presented with bilateral pedal edema and periorbital puffiness. Investigations revealed normal creatinine levels, urinalysis showing 3+ proteinuria, and a renal biopsy displaying normal glomeruli with lipid droplets in the tubules. Both light microscopy and immunofluorescence showed no glomerular abnormalities. What is the likely diagnosis?

A 30-year-old man recently diagnosed with hepatitis B started treatment after a thorough assessment of viral markers. Within a few days, he developed generalized body swelling. Further investigations revealed:

• Serum albumin: 1.9 g/dL
• Urinalysis: Protein (4+) and blood (1+)
• 24-hour urine protein: 6 g

What is the diagnosis?

A middle-aged man recently diagnosed with focal segmental glomerulosclerosis, who had started treatment with cyclophosphamide and prednisolone, presented to the emergency department with sudden and intense right flank pain. Investigations revealed a creatinine level of 6.7, and urinalysis showed a significant presence of red blood cells. His previous medical records indicated a serum creatinine level of 1.4. What is the likely diagnosis in this case?

A female presented with bilateral lower limb swelling, periorbital edema, and hypertension. Her investigations revealed:

• Urinalysis: Proteinuria (3+), RBCs (20/HPF)
• 24-hour urine protein: 6 grams
• Renal biopsy: Mesangial and capillary immune deposits, hyaline thrombi, and uniform thickening of peripheral capillary loops
• Immunofluorescence: Positive staining for IgG, IgM, IgA, C3, and C1q in both mesangial and subendothelial deposits

What is the likely diagnosis in this case?

A female patient who was recently diagnosed with HIV developed bilateral pedal edema, periorbital swelling, anemia, and significant proteinuria (3+). After two years, a renal biopsy was performed. What histological lesion is anticipated in the renal biopsy?

A patient with a history of multiple myeloma presented with generalized edema. Investigations revealed an albumin level of 2.3 g/dL, a creatinine level of 1.4 mg/dL, and a 24-hour urinary protein excretion of 5 grams. A renal biopsy showed findings consistent with focal segmental glomerulosclerosis. What is the underlying cause of the generalized edema in this patient?

A 24-year-old male presented with complaints of dark-colored urine. His vital signs were as follows: blood pressure of 140/90 mmHg, pulse of 90/min regular, and temperature of 99°F. Investigations revealed:

• Urinalysis: Blood 2+, Protein 2+
• CBC: 6700
• Hemoglobin: 12.1 g/dL
• Platelets: 150,000
• Serum electrolytes: Normal
• Creatinine: 1.5 mg/dL

He also reported a sore throat, myalgias, and occasional cough for the past 3 days, along with a history of a similar episode of hematuria, fever, and sore throat. What is the most appropriate investigation to confirm the diagnosis?

A 25-year-old male presented with hematuria for the past 2 days, along with severe sore throat and myalgias for the past 5 days. His blood pressure was 110/70 mmHg. Physical examination was normal except for mild periorbital puffiness. Investigations showed:

• Urinalysis: 2+ blood, 2+ protein
• CBC: Normal
• Serum electrolytes: Normal
• Creatinine: 1.4 mg/dL

What is the most likely diagnosis?

A 22-year-old male presented with complaints of hematuria for 1 day. He has a history of asthma and recently developed shortness of breath, fever, and cough. He was prescribed antibiotics for a respiratory tract infection 3 days ago. His blood pressure was 130/85 mmHg. Investigations revealed:

• Creatinine: 1.6 mg/dL
• Urinalysis: Blood 3+, protein 1+, red cell casts present
• Renal biopsy: Diffuse mesangial proliferation with crescent-shaped necrotizing lesions

What is the most appropriate treatment for this patient?

A 16-year-old boy presented with hematuria and a respiratory tract infection. His blood pressure was 125/75 mmHg. Investigations revealed:

• Urinalysis: Protein 2+, blood 3+
• Urine C/S: No growth
• Creatinine: 1.5 mg/dL
• Urea: 90 mg/dL
• CBC: Normal
• Serum electrolytes: Normal
• Renal biopsy: Focal proliferative glomerulonephritis with mesangial IgA deposition

What is the diagnosis?

A 40-year-old male came to the OPD for a follow-up with worsening bilateral pedal edema. He was diagnosed with IgA nephropathy 8 years ago. On examination, his blood pressure was 150/90 mmHg, and he had bilateral pitting pedal edema. Investigations revealed:

• Urinalysis: Protein 3+, blood 1+
• 24-hour urinary protein: 4.9 grams
• Creatinine: 3.7 mg/dL
• Renal biopsy: Extensive sclerosis, IgA nephropathy

What is the most appropriate treatment for this patient?

A 29-year-old male was referred with complaints of persistent microscopic hematuria, which was identified during the evaluation of recently diagnosed celiac disease. His blood pressure was 110/70 mmHg, and he was recently started on dapsone. Prior investigations revealed:

• Hemoglobin: 10.5 g/dL
• MCV: 65 fL
• Platelets: 395,000
• WBCs: 9,500
• Creatinine: 1.2 mg/dL
• Urinalysis: Protein 2+; microscopic examination showed red blood cells
• 24-hour urinary protein: 1.5 grams
• IgA: 2.2 g/L (0.8–3.2)
• IgG: 9 g/L (6–14)
• IgM: 1.0 g/L (0.5–3)
• Renal biopsy: Mesangial proliferation

What is the most likely diagnosis?

A 20-year-old male came to the OPD for follow-up with the following new investigation results:

• Creatinine: 1.0 mg/dL
• Urinalysis: Blood 2+, Protein 2+
• ANA: Negative
• Anti-dsDNA antibodies: Negative

His medical history showed that he had fever, sore throat, and headache. On examination, his pulse was 92/min, regular, blood pressure was 156/90 mmHg, and there was a soft systolic localized murmur at the left sternal edge. His previous investigations revealed:

• WBC: 11,900
• Hb: 13 g/dL
• Platelets: 216,000
• Creatinine: 1.6 mg/dL
• Serum electrolytes: Normal
• Throat swab culture: No growth
• Urinalysis: 15 red blood cells, granular casts

What is the most likely diagnosis?

A 30-year-old male was diagnosed with minimal change glomerulonephritis for the second time. He had been taking 5 mg of prednisolone, tapered down from 60 mg a day. At this visit, he was advised to discontinue prednisolone. All clinical examinations were normal. His creatinine was 0.9 mg/dl, and all other investigations, including urinalysis, were normal. What is the risk of progression to renal failure over the next 10 years?

A 25-year-old male presented with frothy urine and early morning facial puffiness. He had visited the OPD 4 days ago and was started on co-amoxiclav for a respiratory tract infection. His blood pressure was 160/70 mmHg, and he had pitting edema. His investigations showed:

• Creatinine: 1.4 mg/dl
• Albumin: 2.2 g/dl
• Urinalysis: Protein 3+

His medical record indicated that he was treated with glucocorticoids for minimal change disease 3 years ago. What is the most likely diagnosis?

A 22-year-old female presented to the OPD with complaints of bilateral pedal edema and shortness of breath on exertion. On examination, she had mild facial puffiness, blood pressure of 155/90 mmHg, bilateral pitting edema, and periorbital puffiness. Her investigations showed:

• WBCs: 5500
• Hemoglobin: 8.7 g/dl
• Platelets: 234,000
• Creatinine: 1.1 mg/dl
• USG abdomen: Moderate ascites
• CXR: Minimal bilateral pleural effusion
• Urinalysis: 4+ proteinuria with no red blood cells
• 24-hour urinary protein: 4.4 grams
• Total Cholesterol: 540 mg/dl
• Fasting blood sugar: 102 mg/dl

What is the most likely diagnosis?

A 13-year-old boy presented with complaints of progressively worsening bilateral lower limb edema. On examination, his blood pressure was 110/65 mmHg, and he had pitting edema. Cardiovascular and respiratory examinations were normal. His investigations showed:

• Creatinine: 0.7 mg/dl
• Urinalysis: 4+ proteinuria
• Serum albumin: 2.2 g/dl
• 24-hour urinary protein: 3.7 grams

What is the most appropriate initial treatment?

A 10-year-old boy presented to the emergency department with complaints of abdominal distension and right upper quadrant pain. He had a history of ankle edema over the past few months. On examination, his blood pressure was 100/60 mmHg, pulse 74/min regular, temperature 96°F, with tenderness in the epigastrium and right upper quadrant, and shifting dullness was present. His medical record showed that he was diagnosed with minimal change disease 2 months ago and received prednisolone, which resolved his previous symptoms. His investigations showed:

• Creatinine: 0.6 mg/dl
• 24-hour urinary protein: 5.0 grams
• Serum albumin: 3.3 g/dl
• WBC: 6000
• Hemoglobin: 10.5 g/dl
• Platelets: 298,000
• Bilirubin: 5.5 mg/dl
• ALT: 90 IU/l
• Alkaline phosphatase: 65 IU/l
• Ascitic fluid: 6 g/l

What is the diagnosis?

A 40-year-old male presented with anasarca. He has a history of 20 pack years of smoking and excessive alcohol intake. His blood pressure was 150/90 mmHg, and he had some injection marks on his arm. On examination, he had bilateral pitting edema, stony dull percussion notes on the bilateral basal areas, and shifting dullness on percussion. His investigations showed:

• Creatinine: 0.9 mg/dl
• Albumin: 2.5 g/dl
• Urinalysis: Protein 3+
• 24-hour urinary protein: Focal segmental glomerulosclerosis

What is the most likely cause of FSGS in this patient?

A 65-year-old male presented to the emergency department with a blood pressure of 190/90 mmHg. On examination, he had bilateral pitting edema. His investigations showed:

• Creatinine: 1.9 mg/dl
• Urinalysis: Protein 3+
• 24-hour urinary protein: 3.7 g
• Hemoglobin: 11.25 g/dl
• Serum calcium: 8.5 mg/dl (normal range: 8.5 to 10.5 mg/dl)
• IgA: 0.7 g/l (normal range: 0.8 to 3.0 g/l)
• IgG: 10 g/l (normal range: 8 to 15 g/l)
• IgM: 1.0 g/l (normal range: 0.5 to 3 g/l)

What is the most likely diagnosis?

A 25-year-old male presented with complaints of lower limb edema on both sides along with abdominal swelling. He is a farmer who primarily works with his father. On examination, he had bilateral pitting edema, positive shifting dullness, hepatosplenomegaly, and bibasal decreased breath sounds with dull percussion notes. His heart sounds were normal, with no added sounds. His investigations showed:

• WBCs: 10,500
• Hemoglobin: 10 g/dl
• Creatinine: 1.5 mg/dl
• Albumin: 2.8 g/dl
• Urinalysis: Protein 3+

What is the most likely diagnosis?

A 55-year-old male presented with generalized body swelling. He has a history of 35 pack years of smoking and frequent alcohol use beyond safe limits. He has also developed fever, cough, and hemoptysis over the past few months. On examination, his blood pressure was 150/80 mmHg, he had pitting pedal edema, shifting dullness, decreased breath sounds, and dull percussion notes. His temperature was 100°F. The first and second heart sounds were normal, with no added sounds. His investigations showed:

• Hemoglobin: 10.4 g/dl
• WBC: 11,500
• Platelets: 295,000
• Creatinine: 2.3 mg/dl
• Urinalysis: Protein 3+
• Chest X-ray: Bulky right hilum
• Abdominal ultrasound: Moderate ascites with normal-sized liver and kidneys
• 24-hour urinary protein: 4.4 grams

A renal biopsy was performed, and the results are awaited. What are the expected findings on the renal biopsy?

A 30-year-old female presented to the OPD with complaints of bilateral lower limb edema up to the mid-shin. She was being treated for rheumatoid arthritis and hypertension, receiving NSAIDs and losartan. Her condition worsened after penicillamine was added. On examination, her blood pressure was 130/90 mmHg, and her pulse was 80/min and regular. Cardiovascular examinations were normal. Her investigations showed:

• Creatinine: 0.7 mg/dl
• CBC: Normal
• Serum electrolytes: Normal
• LFTs: Normal
• Albumin: 2.8 g/dl
• Urinalysis: Protein 3+

What is the preferred treatment?

A 55-year-old male who underwent a renal transplant 5 months ago presented with complaints of tenderness over the transplanted kidney. His creatinine level, which previously remained at 1.4 mg/dl, has now increased to 6.4 mg/dl. His blood pressure was 160/70 mmHg. Recurrence of the renal disease is suspected. What is the likely pathology?

A 25-year-old female presented with dark-colored urine for the past 2 days and slight periorbital puffiness. She has no history of major illness but received antibiotics for an ear lobe infection after piercing 25 days ago, which she discontinued due to diarrhea. On examination, her blood pressure was 120/75 mmHg, and she had bilateral pitting edema and facial puffiness. Her investigations revealed:

• – Urinalysis: Protein 3+, Blood 3+

What is the most likely diagnosis?