Rosh Internal Medicine Boost Practice Exam

What is the most likely diagnosis for a patient presenting with acute hematuria and facial edema following a sore throat?

1. Acute poststreptococcal glomerulonephritis

2. Idiopathic hematuria

3. Immunoglobulin A nephropathy

4. Minimal change disease

The correct answer is: Acute poststreptococcal glomerulonephritis

The presentation of acute hematuria and facial edema following a sore throat strongly suggests acute poststreptococcal glomerulonephritis (APSGN). This condition typically occurs after a streptococcal throat infection, where the immune response to the bacteria leads to inflammation of the glomeruli in the kidneys. The facial edema observed is a key finding, as it is often associated with fluid retention due to the glomerular injury and decreased kidney filtration. Hematuria, or blood in the urine, occurs due to damage to the glomeruli, allowing red blood cells to pass into the urine. The time frame of a sore throat followed by symptoms fits perfectly with the classic presentation of APSGN. In contrast, other conditions such as idiopathic hematuria are usually characterized by blood in the urine without accompanying systemic symptoms, and they often don't follow an infectious illness. Immunoglobulin A nephropathy typically presents with episodic hematuria that is often associated with respiratory infections, but it is not usually preceded by a sore throat. Minimal change disease primarily presents with nephrotic syndrome rather than hematuria and edema occurring after an acute infection. Thus, the correlation of the recent respiratory infection with the subsequent