Question-226

A 25 year old man with dyspnea, ankle oedema and ascites. On auscultation - bilateral crackles. On chest xray – bilateral infiltrates, although heart shape is normal. In urine blood +++, protein +++.

What is the most likely diagnosis?


a. SLE
b. IgA nephropathy
c. poststrep GN
d. polyarteritis nodosa
e. anti-glomerular basement dx.

b)IgA nephropathy

physical examination findings in patients with IgA nephropathy are usually unremarkable. A minority of patients have hypertension.
http://emedicine.medscape.com/article/239927-clinical#a0218

•Membranous lupus nephritis – Peripheral edema, ascites, and pleural and pericardial effusions without hypertension
With focal and diffuse lupus nephritis, the physical examination may reveal evidence of generalized active SLE with the presence of a rash, oral or nasal ulcers, synovitis, or serositis. Signs of active nephritis are also common.

With active lupus nephritis, patients have hypertension, peripheral edema, and, occasionally, cardiac decompensation.

With membranous lupus nephritis, signs of an isolated nephrotic syndrome are common. These include peripheral edema, ascites, and pleural and pericardial effusions without hypertension.

http://emedicine.medscape.com/article/330369-clinical#a0256
I am sure the answer would not be IgA nephropathy .Howevre, option a is the most accurate followed by C

e