Review Question - QID 107001

This patient's clinical presentation is consistent with Hodgkin's lymphoma with subsequent minimal change disease.

Minimal change disease is the most common type of nephrotic syndrome in children (focal segmental glomerulosclerosis is the most common cause of nephrotic syndrome in adults), but may also be seen in adults in association with Hodgkin's and non-Hodgkin's lymphomas and leukemia. It is characterized by normal biopsy findings on microscopic examination, with a loss of podocytes visible on electron microscopy. Other findings on electron microscopy include vacuolation and the presence of microvilli (Illustrations A and B).

Figure A shows Reed-Sternberg cells on a bone marrow biopsy, which are indicative of Hodgkin's lymphoma. Illustration A shows an electron micrograph with minimal change disease.
Illustration B shows the features of an minimal change disease that can be observed on electron microscopy.
Illustration C shows a typical histopathologic slide of minimal change disease, which is notable for normal glomeruli.

Incorrect Answers:
Answer 1: RPGN is characterized by crescent moon-shaped glomeruli and is associated with a rapid decrease in GFR. Goodpasture syndrome is associated with this pathology.
Answer 2: Amyloidosis of the kidney is characterized by amyloid protein deposits within the glomeruli.
Answer 3: MPGN is characterized by a thickened basement membrane that leads to activation of complement. Hepatitis C is associated with this pathology.
Answer 4: FSGS is the most common nephrotic syndrome in adults and is characterized by focal (only some glomeruli affected) and segmental (only part of each affected glomerulus is damaged) pathology.