CORRECT ANSWER IS B
1.Progression to nephrotic syndrome at such a rapid pace is not typical of chronic diabetic nephropathy.
2. Avastin – Bevacizumab is a human monoclonal antibody against VEGF. It is known to cause is known to cause damage to endothelial cells that can lead to a pattern resembling acute thrombotic microangiopathy. The von Willebrand factor-cleaving protease (ADAMTS13) was 120% of reference range activity, ruling out any ADAMTS13 deficiency and thrombotic thrombocytopenic purpura. No diarrhea was noted, which suggests that there was no typical hemolytic uremic syndrome.
3.Renal vein thrombosis (RVT) describes a condition in which thrombus forms in the renal veins or their branches. – It should be suspected in patients with nephrotic syndrome who present with new onset of flank pain or generalized abdominal pain, new onset of gross hematuria, or unexplained AKI. Bilateral acute RVT can present with acute kidney injury (AKI) and typically presents with symptoms of renal infarction, including flank pain, microscopic or gross hematuria, a marked elevation in serum lactate dehydrogenase (without change in transaminases). chronic RVT most often has an insidious onset and produces no symptoms referable to the kidney.
4.Cryoglobulinemia is defined as the persistent presence in serum of abnormal immunoglobulins (Igs) that precipitate at low temperatures and dissolve again upon warming. In type I cryoglobulinemia, the cryoglobins are monoclonal antibodies typically IgG or IgM or free Ig light chains which develop in setting of protein-secreting monoclonal gammopathies. On light and immunofluorescence microscopy, membranoproliferative pattern of injury of glomerulonephritis is most commonly observed (in 60 to 80 percent), with endocapillary proliferation and subendothelial and/or intraluminal deposits of cryoglobulins, Igs, and/or complement proteins. Patients have nephritic/nephrotic syndrome with various levels of kidney dysfunction. Abnormal serologic studies include low C4 in three-quarters and low C3 in half. Less commonly seen, mesangial proliferative glomerulonephropathy, intraglomerular hyaline thrombi, and vasculitis with fibrinoid necrosis are seen. Eosinophilic refractile intracapillary “cryo-plugs” that are strongly periodic acid–Schiff (PAS) positive are due to the IgM component of these deposits. In this Patient Immunofluorescence was negative and also complement studies are normal.
REFERENCE
A severe case of bevacizumab-induced thrombotic microangiopathy – PubMed (nih.gov)
Bevacizumab-associated glomerular microangiopathy – PubMed (nih.gov)
