Renal Pathology, Set 2

For each of the following patients, select the most likely pathologic finding:

1. A 55-year-old woman has increasing fatigue for the past year. Her blood pressure is 155/95 mm Hg. Her serum creatinine is now 3.8 mg/dL with urea nitrogen 35 mg/dL. Both kidneys are markedly enlarged on an abdominal ultrasonographic scan. Her mother and brother are similarly affected:

2. A 38-year-old woman has had hypertension for years. She develops severe headaches, and her blood pressure is now 310/150 mm Hg:

3. A 27-year-old man develops a high fever. On physical examination, a cardiac murmur is present. An echocardiogram shows a large vegetation of his mitral valve. A blood culture is positive for Streptococcus viridans. A urinalysis shows pH 6.5, sp gr 1.020, no glucose, no protein, 3+ blood, and no ketones. Urine microscopic examination shows numerous RBCs/hpf, few WBCs/hpf, and no casts or crystals:

4. A 72-year-old man has worsening fatigue and malaise for the past year. His serum creatinine is found to be 5.8 mg/dL with urea nitrogen 56 mg/dL. A urinalysis shows pH 6, sp gr 1.010, no blood, no glucose, no protein, and no ketones. Urine microscopic examinatiion shows only a few oxalate crystals. An intravenous urogram shows bilaterally dilated ureters and renal pelves:

5. A 5-year-old girl who feels listless has periorbital edema. Her serum creatinine is 2.8 mg/dL with urea nitrogen of 24 mg/dL. A urinalysis shows pH 5.5, sp gr 1.015, no blood, 4+ protein, no glucose, and no ketones. Urine microscopic examination shows no casts or crystals, but there are oval fat bodies:

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