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Difficulty: HardNephrology

Match each patient's clinical presentation with the classic renal biopsy finding most likely to be seen in their condition.

  • A 32-year-old woman with systemic lupus erythematosus presents with hypertension, erythrocyte casts, and a rising serum creatinine.Subendothelial immune complex deposits creating a 'wire loop' appearance on light microscopy.
  • A 48-year-old man with chronic hepatitis C and mixed cryoglobulinemia develops new-onset hematuria and proteinuria.Thickened glomerular basement membrane with subendothelial deposits and mesangial interposition, forming a 'tram-track' appearance.
  • A 55-year-old man with untreated HIV infection presents with severe generalized edema and 8 g/day of proteinuria.Segmental sclerosis of the glomerular tuft on light microscopy with diffuse podocyte foot process effacement on electron microscopy.
  • A 60-year-old man with recently diagnosed colon cancer presents with anasarca, normal renal function, and heavy proteinuria.Diffuse thickening of the glomerular basement membrane with subepithelial deposits showing a 'spike and dome' pattern on silver stain.
  • A 22-year-old man with a family history of renal failure presents with microscopic hematuria, sensorineural deafness, and anterior lenticonus.Irregular thickening, thinning, and lamellation of the glomerular basement membrane with a 'basket-weave' appearance on electron microscopy.

Answer

DPGN corresponds to wire loops; MPGN corresponds to tram-track appearance; FSGS corresponds to segmental sclerosis; Membranous nephropathy corresponds to spike and dome pattern; Alport syndrome corresponds to basket-weave appearance.
Each vignette represents a classic systemic trigger for a specific glomerular disease. By recognizing the associations (SLE with DPGN, HCV with MPGN, HIV with FSGS, solid tumor with Membranous Nephropathy, and type IV collagen defect with Alport syndrome), one can definitively pair the clinical presentation with its pathognomonic microscopic description.

Step-by-Step Solution

1
Analyze the SLE vignette (left_1).
Identifies Diffuse Proliferative Glomerulonephritis (DPGN).
SLE with nephritic syndrome and active urinary sediment points to DPGN, which matches with 'wire loop' subendothelial deposits.
2
Analyze the Hepatitis C and cryoglobulinemia vignette (left_2).
Identifies Membranoproliferative Glomerulonephritis (MPGN) Type 1.
Chronic HCV and cryoglobulinemia are strong triggers for MPGN, matching with mesangial interposition and the 'tram-track' appearance.
3
Analyze the HIV infection vignette (left_3).
Identifies Focal Segmental Glomerulosclerosis (FSGS).
Uncontrolled HIV is classically associated with the collapsing variant of FSGS, which presents with massive proteinuria and segmental sclerosis.
4
Analyze the colon cancer vignette (left_4).
Identifies Membranous Nephropathy.
Solid organ malignancies can precipitate secondary Membranous Nephropathy, matching the subepithelial 'spike and dome' appearance.
5
Analyze the familial deafness and lenticonus vignette (left_5).
Identifies Alport Syndrome.
The clinical triad is pathognomonic for Alport syndrome, caused by a type IV collagen defect, matching the 'basket-weave' GBM finding.

Key Concept

Correlation of systemic diseases with secondary glomerular pathologies and their classic microscopic findings.
Estimated Time:2m 0s
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Topics

Nephrology

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