Medical intern examination

It occur as a common pathway resulting from a variety of initiating causes: epidemic, diarrhea-associated HUS is the most common form. Atypical HUS (also known as sporadic or nondiarrhea-associated HUS) occurs less frequently in children and is classified according to the suspected underlying primary cause Typically the illness affects infants and young children of all races and both genders, with the majority of diarrhea-associated cases occurring in the summer months. Even in nonepidemic areas, cases commonly cluster. Although the frequency varies, typical childhood HUS is one of the most common causes of acute renal failure among pediatric patients. The diarrheal form of HUS in children is associated most commonly with colonic infection by Escherichia coli (most commonly E. coli subtype 0157:H7) capable of producing a Shiga-like toxin HISTORY The child who has typical HUS usually experiences a 3- to 10-day prodrome of bloody or watery diarrhea often associated with cr

ETIOLOGY Henoch-Schönlein purpura (HSP) is a vasculitis of unknown etiology characterized by inflammation of small blood vessels with leukocytic infiltration of tissue, hemorrhage, and ischemia. The immune complexes associated with HSP are predominantly composed of IgA EPIDEMIOLOGY It occurs primarily in children 3 to 15 years of age, although it has been described in adults. HSP is slightly more common in boys than girls and occurs more frequently in the winter than the summer months CLINICAL MANIFESTATIONS HSP is characterized by rash, arthritis, and, less frequently, gastrointestinal or renal vasculitis. The hallmark of HSP is palpable purpura, caused by small vessel inflammation in the skin leading to extravasation of blood into the surrounding tissues. IgA often is deposited in the lesions. Although the rash can occur anywhere on the body, it is classically, below the waist on the buttocks and lower extremities Arthritis occurs in 80% of patients with HSP; it can

Nephrotic syndrome is defined by the clinical findings of heavy proteinuria, hypoalbuminemia,generalized edema and hyperlipidemia. EPIDEMIOLOGY examples of Primary and Secondary Causes Minimal change nephrotic syndrome Focal segmental glomerulosclerosis Mesangial hypercellularity Membranoproliferative glomerulonephritis Membranous nephropathy Secondary Nephrotic Syndrome Minimal change nephrotic syndrome (MCNS) is the most common histologic form of primary nephrotic syndrome in children. More than 80% of children under 7 years of age with nephrotic syndrome have MCNS. Children 7 to 16 years old with NS have a 50% chance of having MCNS, and males are affected more frequently than females (2:1). The male-to-female ratio is reported to be 2:1 for children and 1:1 in adolescents and adults. most of minimal change nephrotic syndrome (MCNS) have remission of their disease with a course ofprednisone. pathophysiology Nephrotic syndrome (NS) is characterized by persis