Secondary IgA Nephropathy Conditions, Immunoglobulin A (IgA) Nephropathy, Glomerulonephritis: Causes скачать в хорошем качестве

Secondary IgA Nephropathy Conditions, Immunoglobulin A (IgA) Nephropathy, Glomerulonephritis: Causes

A 12-year-old girl with MEN2B, history of thyroidectomy, and intermittent cola-colored urine is found to have microalbuminuria, dysmorphic erythrocytes, and RBC casts. How should clinicians approach the diagnostic evaluation of secondary causes of IgA-dominant glomerular disease in a child with these findings, while weighing value-based choices and minimizing unnecessary invasive procedures? What investigations best clarify the etiology before considering kidney biopsy? VIDEO INFO Category: Secondary IgA Nephropathy Conditions, Immunoglobulin A (IgA) Nephropathy, Glomerulonephritis: Causes, Diagnosis, and Management, Nephrology: Kidney Disease Diagnosis and Management Difficulty: Expert - Expert level - For those seeking deep understanding Question Type: Cost Effectiveness Case Type: Typical Presentation Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 12-year-old girl with genetically confirmed multiple endocrine neoplasia type 2B is referred to pediatric nephrology for intermittent cola-colored urine and new-onset microalbuminuria detected by her primary pediatrician. She lives with her parents, attends middle school, denies tobacco or alcohol, and has no known drug allergies. Past interventions include early prophylactic thyroidectomy and routine MEN2B surveillance.... OPTIONS A. Adopt a tiered, outpatient-first algorithm: repeat urinalysis with uACR confirmation; obtain serologies for HBsAg, anti-HCV, and HIV; screen for celiac disease with tTG-IgA plus total IgA; and send fecal calprotectin to triage for pediatric gastroenterology and colonoscopy only if calprotectin is... B. Adopt a tiered, outpatient algorithm but include immediate endoscopic evaluation (EGD and colonoscopy with biopsies) regardless of fecal calprotectin, and broaden labs to ANA, ANCA, and C1q now to avoid missed extra-renal autoimmune disease despite higher cost and procedural risk. C. Proceed to early kidney biopsy after two consecutive uACR values greater than 100 mg/g and RBC casts despite normal complements, obtaining viral and celiac serologies only after histology to shorten time to a definitive diagnosis. D. Use an outpatient-first pathway with celiac testing by tTG-IgG alone, defer total IgA unless ALT is elevated, obtain a single fecal calprotectin measurement with a high threshold for referral, and reserve viral serologies for children with weight loss or fever. CORRECT ANSWER A. Adopt a tiered, outpatient-first algorithm: repeat urinalysis with uACR confirmation; obtain serologies for HBsAg, anti-HCV, and HIV; screen for celiac disease with tTG-IgA plus total IgA; and send fecal calprotectin to triage for pediatric gastroenterology and colonoscopy only if calprotectin is elevated or alarm features emerge. EXPLANATION In a child with a typical IgA-dominant glomerular presentation and preserved kidney function, the highest-value pre-biopsy evaluation maximizes diagnostic yield while minimizing risk and cost. A tiered outpatient-first algorithm that confirms albuminuria, screens for viral infections associated with secondary IgA disease (HBV, HCV, HIV), tests for celiac disease with tTG-IgA paired with total IgA, and uses fecal calprotectin to triage pediatric gastroenterology referral and endoscopy only if elevated or alarm features emerge, targets common secondary causes efficiently.... Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------