A 23-yr-old white woman presents with recurrent episodes of macroscopic hematuria in the previ- ous 1 yr. Her blood pressure (BP) is 150/95 mmHg. No edema is present. A urinalysis reveals 50 to 100 erythrocytes per high-power field (50% dysmorphic), several erythrocyte casts, and 4⫹ proteinuria. Six months ago, her serum creatinine was 0.9 mg/dl. Her serum creatinine is now 1.9 mg/dl, and a random urine specimen contains 2 g of protein per gram of creatinine. A renal biopsy reveals that 30% of the glomeruli are involved with focal and segmental or circumferential cel- lular crescents. The remaining glomeruli show mesangial proliferation and focal and segmental glomerulosclerosis. The immunofluorescence study shows 3⫹ IgA, 2⫹ IgG, 1⫹ IgM, 3⫹ C3, negative C1q, and 3⫹ fibrin/fibrinogen. In addition to blood pressure (BP) control with an angiotensin converting enzyme (ACE) inhibitor, which ONE of the following therapies would you add to her regimen as initial therapy? A. Fish-oils at 6 g daily. B. Oral prednisone at 60 mg daily. C. Cyclosporine at 5 mg/kg daily. D. Oral prednisone at 60 mg daily; oral cyclo- phosphamide at 1.5 mg/kg daily. E. Oral prednisone at 60 mg daily; oral myco- phenolate mofetil at 1.0 g twice daily.
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Question
A 23-yr-old white woman presents with recurrent episodes of macroscopic hematuria in the previ- ous 1 yr. Her blood pressure (BP) is 150/95 mmHg. No edema is present. A urinalysis reveals 50 to 100 erythrocytes per high-power field (50% dysmorphic), several erythrocyte casts, and 4⫹ proteinuria. Six months ago, her serum creatinine was 0.9 mg/dl. Her serum creatinine is now 1.9 mg/dl, and a random urine specimen contains 2 g of protein per gram of creatinine. A renal biopsy reveals that 30% of the glomeruli are involved with focal and segmental or circumferential cel- lular crescents. The remaining glomeruli show mesangial proliferation and focal and segmental glomerulosclerosis. The immunofluorescence study shows 3⫹ IgA, 2⫹ IgG, 1⫹ IgM, 3⫹ C3, negative C1q, and 3⫹ fibrin/fibrinogen. In addition to blood pressure (BP) control with an angiotensin converting enzyme (ACE) inhibitor, which ONE of the following therapies would you add to her regimen as initial therapy? A. Fish-oils at 6 g daily. B. Oral prednisone at 60 mg daily. C. Cyclosporine at 5 mg/kg daily. D. Oral prednisone at 60 mg daily; oral cyclo- phosphamide at 1.5 mg/kg daily. E. Oral prednisone at 60 mg daily; oral myco- phenolate mofetil at 1.0 g twice daily.
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Question
A 23-yr-old white woman presents with recurrent episodes of macroscopic hematuria in the previ- ous 1 yr. Her blood pressure (BP) is 150/95 mmHg. No edema is present. A urinalysis reveals 50 to 100 erythrocytes per high-power field (50% dysmorphic), several erythrocyte casts, and 4⫹ proteinuria. Six months ago, her serum creatinine was 0.9 mg/dl. Her serum creatinine is now 1.9 mg/dl, and a random urine specimen contains 2 g of protein per gram of creatinine. A renal biopsy reveals that 30% of the glomeruli are involved with focal and segmental or circumferential cel- lular crescents. The remaining glomeruli show mesangial proliferation and focal and segmental glomerulosclerosis. The immunofluorescence study shows 3⫹ IgA, 2⫹ IgG, 1⫹ IgM, 3⫹ C3, negative C1q, and 3⫹ fibrin/fibrinogen. In addition to blood pressure (BP) control with an angiotensin converting enzyme (ACE) inhibitor, which ONE of the following therapies would you add to her regimen as initial therapy? A. Fish-oils at 6 g daily. B. Oral prednisone at 60 mg daily. C. Cyclosporine at 5 mg/kg daily. D. Oral prednisone at 60 mg daily; oral cyclo- phosphamide at 1.5 mg/kg daily. E. Oral prednisone at 60 mg daily; oral myco- phenolate mofetil at 1.0 g twice daily.
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