A 7-year-old boy was brought to his pediatrician because he had developed hematuria, which required hospitalization. Approximately 6 weeks before his admission, he had a severe sore throat but received no treatment for it. Subsequently, he did well except for complaints of mild lethargy and decreased appetite. Approximately 3 weeks before admission, he had a temperature of 101° F daily for 7 days. He complained of minimal bilateral back pain. Physical examination revealed a well-developed young boy with moderate bilateral costovertebral angle (CVA) tenderness. The remainder of the physical examination results were negative. His blood pressure was 140/100 mm Hg in both arms and legs.
Studies Results Urinalysis, p. 956 Blood +4 (normal: negative) Protein +1 (normal: negative) Red blood cell casts Positive (normal: negative) Specific gravity 1.025 (normal: 1.010-1.025) Color Red-tinged (normal: amber-yellow) Urine culture and sensitivity (C&S), p. 973 No growth after 48 hours Blood urea nitrogen (BUN), p. 511 42 mg/dL (normal: 7-20 mg/dL) Creatinine, p. 190 1.8 mg/dL (normal: 0.7-1.5 mg/dL) Creatinine clearance test, p. 193 64 mL/min (normal: approximately 120 mL/min) Renal ultrasound, p. 866 No tumor; kidneys diffusely enlarged and edematous Intravenous pyelogram (IVP), p. 1057 Delayed visualization bilaterally; enlarged kidneys, no tumor; no obstruction seen Renal biopsy, p. 751 Swelling of glomerular tuft, along with polymorphonuclear leukocyte infiltrates in Bowman’s capsule (findings compatible with glomerulonephritis); immunofluorescent staining, positive for IgG Anti-DNase-B (ADB) titer, p. 79 200 units (normal: ≤170 units) Total
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