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NBME 24 Answers

nbme24/Block 1/Question#13

A 4-year-old boy is brought to the emergency ...

Proliferative glomerulonephritis

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 +1  upvote downvote
submitted by mousie(74),

is this subacute endocarditis associated Membrano-proliferative GN?

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 +6  
seagull  The question would be too fair if it just said PSGN. Instead we need to smell our own farts first. +24  
yotsubato  And they used terminology NOT found in FA +4  
water  who said they were limited to FA? +  
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. +1  

 +1  upvote downvote
submitted by dontwanttofail(-4),


Directly from wikipedia:

"Acute proliferative glomerulonephritis is a disorder of the glomeruli (glomerulonephritis), or small blood vessels in the kidneys. It is a common complication of bacterial infections, typically skin infection by Streptococcus bacteria types 12, 4 and 1 (impetigo) but also after streptococcal pharyngitis, for which it is also known as postinfectious or poststreptococcal glomerulonephritis."

 +0  upvote downvote
submitted by nbmehelp(4),

This is BS bc PSGN is like the only nephrotic/nephritic syndrome I thought I had down cold

 +0  upvote downvote
submitted by ap88(0),

Why can this not be papillary necrosis? Given the gross Hematuria and proteinuria with a history of analgesic use... I thought that was what this was getting at?

 -3  upvote downvote
submitted by nwinkelmann(56),

So actually.... Medscape says that PSGN can progressive to a proliferative glomerulonephritis mechanism and so proliferative glomerulonephritis should be considered as a differential diagnosis for PSGN.

https://emedicine.medscape.com/article/980685-overview#a5: "The presence of acute kidney injury may suggest an alternate diagnosis (eg, membranoproliferative glomerulonephritis [MPGN], Henoch-Schönlein purpura [HSP], systemic lupus erythematosus [SLE]) or a severe or worsening APSGN, such as observed in those with crescentic glomerulonephritis or rapidly progressive glomerulonephritis... Differential Diagnosis: This includes most other types of childhood glomerulonephritides. These include IgA nephropathy, membranoproliferative glomerulonephritis, hereditary nephritis, and other forms of postinfectious glomerulonephritis."

Ironically enough, this must be what they were asking, i.e. complications of PSGN, because AMBOSS (another Step resource) directly linked the above article I found before looking farther and coming across the AMBOSS section.