A 12-year-old presents with hypertension and hematuria. Serum C3 is raised. Renal biopsy shows subepithelial hump deposits on EM. What is the most likely diagnosis?

1. A

   A. Goodpasture syndrome

2. B

   B. Membranous glomerulonephritis

3. C

   C. Post-streptococcal glomerulonephritis (PSGN)

4. D

   D. Minimal change disease

Appeared in: INI-CET EXAM -2026

Explanation

• Post-streptococcal glomerulonephritis (PSGN) is the most likely diagnosis given the patient's age (12 years) and presentation with acute nephritic syndrome (hypertension and hematuria).
• The most definitive clue is the renal biopsy finding of 'subepithelial hump deposits' on electron microscopy (EM), which is a pathognomonic feature of PSGN.
• These 'humps' are immune complexes containing streptococcal antigens that have been deposited on the epithelial side of the glomerular basement membrane.
• While the question states serum C3 is raised, a characteristic finding in acute PSGN is a low serum C3 level due to consumption by the alternative complement pathway. The biopsy finding is more specific and diagnostic in this case.

Why Other Options Were Wrong

• Option A: This is an autoimmune disease caused by antibodies against the glomerular basement membrane (anti-GBM), resulting in linear immunofluorescence deposits, not the granular subepithelial humps seen in PSGN.
• Option B: This condition shows subepithelial deposits, but they create a characteristic 'spike and dome' appearance on silver stain, not the 'humps' seen in PSGN. It typically presents with nephrotic syndrome in adults.
• Option D: This is the most common cause of nephrotic syndrome in children, but the glomeruli appear normal on light microscopy, and EM shows effacement of podocyte foot processes without any immune deposits.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Diagnosis of acute glomerulonephritis based on clinical presentation and histopathology to guide bedside assessment, documentation, and the next nursing action.
• Nurses play a key role in managing children with PSGN by closely monitoring blood pressure, managing fluid balance through strict intake/output charting and daily weights, and educating the family on dietary restrictions (low salt, low fluid).
• Recognizing the signs of complications like hypertensive encephalopathy (headache, confusion, seizures) or acute kidney injury (oliguria, rising creatinine) is critical for timely intervention.
• What if? If the patient had been an adult, the prognosis for PSGN would be worse, with a higher risk of progressing to chronic kidney disease or end-stage renal disease compared to the excellent prognosis typically seen in children.

How to Approach the Question

• First, analyze the patient's demographics and primary symptoms: a 12-year-old with hypertension and hematuria points towards an acute nephritic syndrome, common in childhood.
• Next, identify the most specific and definitive piece of information provided. In this case, it is the renal biopsy finding: 'subepithelial hump deposits on EM'.
• Recall or deduce which glomerular disease is characterized by this pathognomonic finding. Subepithelial humps are classic for PSGN.
• Evaluate for conflicting data. The 'raised C3' is inconsistent with PSGN's typical low C3. In such cases, prioritize the pathognomonic histopathology finding over a single lab value, which may be an error in the question stem or an atypical presentation.
• Eliminate other options based on their distinct pathology: Goodpasture (linear IF), Membranous GN (spike and dome), and Minimal Change (foot process effacement).

Concept Tested & Keywords

• Concept Tested: Diagnosis of acute glomerulonephritis based on clinical presentation and histopathology.
• Stem keywords: hypertension, hematuria, serum C3, renal biopsy, subepithelial hump deposits, 12-year-old
• Lead-in keywords: most likely diagnosis
• Clinical cues: The combination of nephritic syndrome (hypertension, hematuria) in a child is a classic presentation for PSGN.
• Clinical cues: The finding of 'subepithelial hump deposits' on electron microscopy is pathognomonic for PSGN.

Question ID

QLZdL16BYo3IfPaEMsH-aG

Copy ID

Reference Book

E6 Pathology-Vandana Puri & Kavita Gaur Textbook of Pathology and Genetics p. 302-304

E6 Medicine Harrison 22e Part 2 p. 321-323