Question

A 48-year-old man presents with complaints of facial puffiness, frothy urine, and hypertension. He gives a history of infection with hepatitis B. Urine examination reveals microscopic hematuria. The histopathological image of the kidney biopsy shows a spike and dome pattern. What is the diagnosis of this condition ?

• A. Minimal change disease
• B. Membranous nephropathy
• C. FSGS
• D. PSGN-associated disease

Answer 1

The Correct Option is B

The patient, a 48-year-old man, presents with facial puffiness, frothy urine, and hypertension. He has a history of hepatitis B infection and microscopic hematuria is noted on urine examination. The kidney biopsy shows a spike and dome pattern histologically. These clinical and pathological findings suggest Membranous nephropathy as the correct diagnosis.

Here is the rationale:

• Facial puffiness, frothy urine, and hypertension: These symptoms are commonly associated with nephrotic syndrome, characterized by significant proteinuria, hypoalbuminemia, and often hyperlipidemia.
• History of hepatitis B infection: Membranous nephropathy is linked with hepatitis B virus infection, among other causes.
• Microscopic hematuria: While not exclusive to membranous nephropathy, it can be present in this condition.
• Histopathological finding: The 'spike and dome' appearance is characteristic of membranous nephropathy, arising from subepithelial immune complex deposits that lead to thickening of the glomerular basement membrane.

Other options consideration:

• Minimal change disease: Typically presents with nephrotic syndrome but without hypertension or microscopic hematuria and there's no spike and dome pattern.
• Focal segmental glomerulosclerosis (FSGS): May present with hypertension and nephrotic syndrome, but histology would show segmental sclerosis and collapsing lesions, not spike and dome.
• PSGN (Post-Streptococcal Glomerulonephritis): Often occurs after streptococcal infections with a different histological presentation of subepithelial 'humps'.

In conclusion, the combination of clinical presentation, history of hepatitis B infection, and the distinctive biopsy findings indicate that the diagnosis is membranous nephropathy.