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medguru2295
This was my precise login. I wound up getting it by elimination. But, didn't like that answer as its uncommon in small children and the child seemingly had no risk factors.
+1
thotcandy
@medguru2295 FA says it's most commonly seen in children and it's selflimited vs adults is rare and can lead to renal insuff
+2
peqmd
They're using the broad category for PSGN, Pathoma pg 130 IIC. PSGN = Hypercellular, inflammed glomeruli on H&E stain and cross referencing the FA table mentioned hypercellular => Proliferative.
+6
unknown001
that was the reason why i chose this answer.
to nbme : thats not cool bro
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thotcandy
I saw BUN/cr > 20 and instantly though prerenal --> ischemic pap necrosis due to analgesics.
Are nephritic syndromes just excluded from that whole thing? FA says BUN and Cr are increased for nephritic syndromes but does the ratio just not matter?
+2
fatboyslim
Ischemic pap necrosis wouldn't have RBC casts
+1
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yiqi
I got wrong for the same reason!!!
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jus2234
The question describes how he had a strep infection 15 days ago, and now this is poststreptococcal glomeruloneprhitis, which can also be described as proliferative glomerulonephritis
+13
seagull
The question would be too fair if it just said PSGN. Instead we need to smell our own farts first.
+73
yotsubato
And they used terminology NOT found in FA
+8
water
who said they were limited to FA?
+5
nbmehelp
FA uses the common nomenclature and the fact most of our other resources use the same nomenclature for this, I think we can agree that is is the accepted terms. If they're gonna decide not to use the nomenclature that most medical students are taught then they should provide their own study materials at that point for us to use. The test shouldn't be this convoluted for no reason.
+11
alimd
Ok. They can use terminology whatever they want. But BUN-CR>20 is CLEARLY prerenal right?
+2
an_improved_me
I think you're talking passed each other. The fact of the matter is that NBME doesn't really care how we prepare. It cares to stratify students using whatever stupid metrics it deems necessary. It's not limited to first-aid, and that doesn't mean that it shouldn't be.
+3
utap2001
Not only RBC cast, but the BUN/Cr ratio>20 can help rule out other possibility. BUN/Cr>20 -> pre-renal-> PSGN. AIN or ATN are renal or post-renal.
+1
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boostcap23
Any amount of RBC casts is an abnormality and indicates tubular pathology. Normally should have none. Just like how even a single neutrophil in CSF is abnormal.
+2
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submitted by โusmile1(154)
Membranous nephropathy and minimal change disease can be easily ruled out as they are nephrotic syndromes. Tubulointerstitial nephritis (aka acute interstitial nephritis) can be ruled out as it causes WBC casts not RBC as seen in this question. Papillary necrosis - either has no casts or it might show WBC casts but not RBC because the problem is not in the glomeruli.
table of nomenclature on page 582 explains that proliferative just means hyper cellular glomeruli. Given the patients history of sore throat two weeks ago, now presenting with Nephritic Syndrome with RBC casts, proliferative glomerulonephritis is the only reasonable answer.