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OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is IgA nephropathy (Berger disease). While this may seem a odd practice, it is useful to see multiple examples of how IgA nephropathy will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for IgA nephropathy.
- Recent history of upper respiratory tract infection: patients will have a recent bout of a respiratory illness (about 5-7 days before the onset of new symptoms for this condition)
- Painless hematuria: lasts for several days then subsides temporarily. Then returns every few months on its own, or with another upper respiratory infection.
- Mesangial hypercellularity can bee seen on light microscopy
QUESTION EXAMPLES
Question # 1
A 14 year old boy is brought to the clinic for a routine exam. He has no past medical history. During the past few years he comments that he has noticed brown urine whenever he has a cold. He denies any dysuria, urinary urgency, or incontinence. A physical exam shows no abnormalities. Lab studies are as follows:
- Urea nitrogen: 16 mg/dL
- Creatinine: 0.9 mg/dL
- C3: 101 mg/dL (N = 83 – 177)
- Urine blood; 4+
- Urine protein: 2+
What diagnosis could explain this presentation?
Explanation # 1
Hematuria when having a cold = IgA nephropathy
Question # 2
Explanation # 2
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
- Underlying cause: deposition of IgA containing complexes in the glomerulus
- Light microscope findings: mesangial hypercellularity
- Immunofluorescence: IgA deposition in the mesangium
- What if there are extra renal symptoms: in the setting of IgA nephropathy PLUS the addition of other symptoms (such as abdominal pain, arthralgia, purpuric skin lesions) the syndrome is called Henoch-Schonlein purpura.
Page Updated: 11.19.2016