Renal Failure ranking question

35yo Caucasian male presents with hypertension, edema, weight gain, hypoalbuminemia, and hyperlipidemia. Microscopy studies showed ‘spike and dome’ pattern of immune deposits on the outside of the glomerular basement membrane. Rank the following diagnoses given this information, with the most likely diagnosis given first.

A) Synpharyngitic glomerulonephritis (aka Berger’s Syndrome, IgA nephropathy )

B)  Focal Segmental Glomerulosclerosis

C) Minimal change Glomerulonephritis

D) Membranous Glomerulonephritis

E) Alport syndrome

For the answers to this question, see below:

This is Membranous Glomerulonephritis (D), a slowly progressive disease of kidney affecting mostly 30 to 50 year old Caucasians, with characteristic ‘spike and dome’ pattern of glomerular basement membrane under light microscopy using Jones’ stain. Based solely on clinical presentation, this patient could have the Focal Segmental Glomerulosclerosis (B), which is the most common cause of idiopathic nephrotic syndrome in adults. Focal Segmental Glomerulosclerosis,where only some glomeruli (hence ‘focal’) and only part of each glomerulus (hence ‘segmental’) are involved, is a cause of nephrotic syndrome in children and adolescents and also occurs in adults. The Minimal change disease (C) is the most common cause of nephrotic syndrome in children. The definitive diagnosis of nephritis should be based on kidney tissue biopsy. Another possibility is synpharyngitic glomerulonephritis (A). In synpharyngitic glomerulonephritis (aka Berger’s Syndrome, IgA nephropathy ), which is common in young adults, patient presents with episodic hematuria (important in this case to exclude kidney stones and bladder cancer) that usually starts within a day or two of a non-specific upper-respiratory tract infection.  Finally (E), Alport syndrome is a hereditatry disease associated with hearing impairment and eye problems.

So the correct ranking is DBCAE.