History and Physical Examination Ms. A.A., a 25-year-old complaining of joint pa

Question

History and Physical Examination

Ms. A.A., a 25-year-old complaining of joint pain, fatigue, and significant weight loss, was seen by her primary care provider. Physical examination demonstrated a maculopapular rash on her face (Figure 1) and chest. Several joints in her hands were swollen. Her temperature was 37.8° C.

Laboratory Data

            Assay                          Patient’s Result         Reference Values

Complete blood count

            Hemoglobin                10.5 mg/dL                 12.0-16.0

            Hematocrit                  32%                             35%-45%

            Total WBC                 9.5 × 109/L                  4.5-10.3

            Platelet count              190 × 109/L                 150-450

            Sedimentation rate      45 mm/hr                    0-20

Urinalysis

            Color                           Red-brown                  straw-yellow

            Protein                         4+                                0-trace

            RBCs                          Large                           Negative

            Microscopic examination

            Many RBCs/hpf, few granular casts, moderate number of RBC and granular casts.

Antinuclear antibody (ANA): positive (a speckled nuclear staining pattern without staining of the nucleoli)

Questions:

1. The patient’s urinalysis results suggest: (5 pts)

a. urinary infection.

b. nephritic condition.

c. renal insufficiency.

d. No significant abnormalities.

2. What rheumatologic disorder is suggested by the patient’s laboratory findings? (5 pts)

3. The speckled antinuclear antibody staining pattern is associated with the following antibody (antibodies): (5 pts)

4. What type(s) of serum antibody (antibodies) can be significant in establishing a diagnosis of a specific rheumatoid disorder? (5 pts)

Explanation / Answer

Excessive protein in the urine (proteinuria) is a sign of kidney involvement. Usually, kidneys prevent protein from passing from your blood into your urine: loops of capillaries (glomeruli) that filter blood allow small particles to pass into the urine while retaining larger particles, such as protein, and kidney tubules reabsorb the smaller proteins that were able to escape. Large amounts of protein in the urine suggest that these glomeruli and tubules are inflamed or damaged in some way.

The presence of red blood cells in the urine is known as hematuria, and the presence of hemoglobin (from red blood cells) is known as hemoglobinuria. Usually people have very small amounts of red blood cells in their urine, but even a minute increase can indicate a problem, such as a disease of the kidney or urinary tract, trauma, medications, smoking, or intense exercise.

1]The patient’s urinalysis results suggest: (b)nephritic condition.

2]Proteinuria ,hematuria, hemoglobinuria(patients blood report suggest lower levels of Hb)

3]The indirect immunofluorescence (IIF) test for antinuclear antibodies (ANA), using the human cell line HEp-2 as substrate, is a commonly used assay to detect human autoantibodies. The results of ANA testing are reported in two parts: the titer of the antibodies and the staining pattern produced by the antibodies. The titer of the antibodies refers to the highest dilution of serum that produces visible fluorescence. The ANA pattern refers to the distribution of staining produced by autoantibodies reacting with antigens in the HEp-2 cell nucleus and cytoplasm.

4]Rheumatoid factors (RFs) are autoantibodies reacting against the Fc region of immunoglobulin (Ig)G.

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