Review Question - QID 104506

This patient presents with nephrotic syndrome, most likely focal segmental glomerulosclerosis (FSGS) (Figure B), which is associated with the African American and Hispanic race, obesity, heroin use, and HIV.

FSGS is the most common cause of nephrotic syndrome in adults behind membranous glomerulonephritis. It typically presents with the findings typical of nephrotic syndrome - edema, fatigue, hypoalbuminemia, proteinuria, and hyperlipidemia. It is commonly associated with African American and Hispanic patients, obesity, heroin use, and HIV. On kidney biopsy, focal areas of segmental sclerosis are observed as shown in Figure B. Prognosis tends to be poor due to refractory disease.

Figures A and C-E as well as Illustrations B-D are described in the incorrect answer choices below. Illustration A is a labeled kidney biopsy of a patient with FSGS. Illustration E illustrates PSGN with diffuse hypercellularity with neutrophils (and lymphocytes).

Incorrect answer:
Answer 1: Figure A demonstrates the histologic image associated with a normal glomeruli.
Answer 3: Figure C demonstrates the histologic image associated with diabetic glomerulonephropathy. Note the mesangial expansion and eosinophilic nodular glomerulosclerosis (Kimmelstiel-Wilson lesion) as seen in Illustration B.
Answer 4: Figure D demonstrates the histologic image associated with rapidly progressive (crescentic) glomerulonephritis (RPGN). Note the crescentic moon shape of fibrin and plasma protein deposition as seen in Illustration C.
Answer 5: Figure E demonstrates demonstrates the LM findings of diffuse proliferative glomerulonephritis (DPGN). Note the "wire looping" appearance of the capillaries as seen in Illustration D. The is the most common cause of death in lupus.