CASE ANALYSIS- SEPTEMBER 3, 2021

BERGER’S DISEASE / IgA NEPHROPATHY

Case:
§ A 15-year old SH student is suffering from recurring extremity numbness ad
hypothermic toes.
§ She is living with her father and three older brothers who are chronic smokers
§ On examination, the doctor noted no palpable pulses on the lower extremity
§ She also suffered from painful extremities for the past week. This pain goes away when
she is at rest.
§ Several open ulcers of the fingers and palms were also noted.
§ The following are significant lab results:
o Serum cholesterol: 340 mg/dL
o Platelet: 85 mg/dL
o Fibrinogen: 120 mg/dL
o A/G ratio: decreased
o Urine: Blood 3+
o Urine microscopy: Intact RBCs (12-16 hpf)
o GFR: decrased

Questions:
1. What is the patient's condition?
2. Provide the complete pathophysiology of the disease.
3. Explain the A/G ratio result and correlate it with the other signs/symptoms.
4. List 5 diagnostic tools a physician may use for diagnosis and provide a description for
each.
5. Provide medications that address not only the main cause but also the accompanying
disease manifestation.

Sir Jericho Case Questions:

What type of Gangrene is seen in this disease?
- ANSWER: Dry gangrene ( seen in arterial obstruction)
- Wet gangrene (Venous obstruction)

Why is there a need for COX (medication)?

- COX-2 inhibitors are NSAIDs that selectively block the COX-2 enzyme and not
the COX-1 enzyme. Blocking this enzyme impedes the production of prostaglandins
by the COX-2 which is more often the cause the pain and swelling of inflammation
and other painful conditions.
- Alleviate pain or suffering

Why is Codeine utilized as a medication for this condition?

 - It works by changing the way the body senses pain and by cooling the body.
Codeine belongs to a class of medications called opiate (narcotic) analgesics and to a
class of medications called antitussives. When codeine is used to treat pain, it works
by changing the way the brain and nervous system respond to pain.
- It is the proform of MORPHINE
- Morphine is the best opiod analgesic
- Upon metabolism, it can be induced into an active morphine form which alleviates
pain

Leakage of albumin to other body sites. Is the decrease in A/G ratio only associated with
the leakage
- Due to the increase in IgA
- There is a decrease in ONCOTIC pressure (oncotic pressure is influenced by albumin)

What is the other name of Buerger disease?

- IgA Nepropathy

What is the end effect of albumin leakage?

- Edema
- Generalized edema (most tissues have edema): ANASARCHA

Explain positive or negative Allan’s Test.

- Allan’s test is used to determine if there is appropriate or adequate supply of blood
- The test is negative when there is a return of normal color to both hands
during occlusion of either artery alone. A positive test will be with persistent pallor
in the palm, indicating no collateral blood flow to the hand.
- Positive: No return of flushing after 10-15 seconds. No sufficient blood supply ( you
will know the patient is suffering from occlusion)
- Negative: return of flushing after 10-15 seconds. GOOD
- Simple Allen’s Test: only one hand or arm
- Modified Allen’s Test: Two hands or arm

What is the end effect of thrombosis why the patient suffered from gangrene?
- Embolus

Why are vasculatures occluded (what is the source of occlusion)?

- Embolus
- Embolism occurs when a piece of a blood clot, foreign object, or other bodily
substance becomes stuck in a blood vessel and largely obstructs the flow of blood.

Why PMNs predominate in this condition?

- Granulomas are formed in PMNs which lead to the formation of a thrombus, so ang
PMNs are part of a thrombus, pero ngaa may increase ka PMN before this ?
 - The PMNs are the earliest repsonders to inflammation or damage, so may concurrent
damage sa blood vessels, so kay damage, ang PMNs ga respond which ingest materials
from the site of injury
- They are first responders! Together with the chemokines
- They become trap sa formation of thrombus

What condition is similar to Berger’s disease that is related to coldness or numbness together
with tingling sensation (Reynaud’s syndrome) and this syndrome is usually mistaken as
Berger’s due to these manifestations? (What condition is similar to Reynaud’s syndrome
phenomenon that may be mistaken as Berger’s, and what lab test is used to differentiate it?
- This test is positive for CAD but negative for Berger’s (ANSWER: CAT or Cold Agglutinin
Test)

What other APR is inversely proportional (the protein that decreases during inflammation)?
- This protein decreases together with albumin
- CRP is a positive ADR
- transferrin