A previously healthy 20-year-old college student presents to the student health office complaining of a 1-week history of fatigue and dark-colored urine. On physical examination, his blood pressure is 155/90 mm Hg and his serum creatinine level is 4.4 mg/dL. Urinalysis shows 3+ blood and red cell casts without protein, glucose, or ketones. A kidneys biopsy shows crescentic changes of the glomerulus. Which of the following is the most likely diagnosis? (A) Diabetic nephropathy (B) Membranoproliferative glomerulonephritis (C) Minimal change disease (D) Rapidly progressive glomerulonephritis (E) Systemic lupus erythematosus

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Respected mam, thank you for sharing this mcq. Clinical diagnosis : ACUTE NEPHRITIC SYNDROME with ACUTE KIDNEY INJURY (AKI): 1. Hypertension 2. Hematuria 3. Raised serum creatinine Biopsy : Crescentric changes. Now with h/o acute renal failure with crescents the patient is suffering from RAPIDLY PROGRESSIVE GLOMEULONEPHRITIS (RPGN). Hence thr most likely diagnosis in this case is RPGN. Ans : D ( RPGN) SLE (option E) is a systemic disease and a known cause of RPGN. This patient needs to be further evaluated ( ANA, Anti ds DNA, Anti Sm antibodies)and clinical criteria to rule out SLE. Immunofluorescence in SLE may show a characteristic full house pattern ( positive for IgG, IgM, IgA, C3 and fibrinogen). Also the most common cause of RPGN is ANCA mediated i.e Wegeners, microscopic polyangitis. Hence serum ANCA studies needs to be done. With the provided details it's a case of RPGN. The patient needs to be evaluated further for the etiology. Thank you mam. Regards...

nice explanation sir
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RPGN. Here we need to be aggressive in diagnosis and management. causes like Anti GBM antibodies need to be evaluated and promptly started on plasmapheresis or immunosuppression along with hemodialysis...

A- Diabetic nephropathy.

D. RPGN

But I have a doubt ma'am. SLE is also an etiological cause of RPGN. So how to narrow it down? Immunofluorescence ?
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