Recurrent orange urine and abdominal pain in a 13-year-old boy

摘要

A 13-year-old boy presents with acute kidney injury (creatinine level, 5.6 mg/dL [495 mumol/L]) and hypertension (blood pressure, 133/59 mm Hg). He notes 18 months of recurrent monthly episodes of back and abdominal pain, dark orange discoloration of urine, difficulty voiding, nausea, and anorexia. Most episodes occur the evening or morning after a day playing outside vigorously. His history includes anemia empirically treated with iron since childhood and occasional staring spells not previously investigated. Physical examination reveals an obese white boy without obvious dysmorphic features, abdominal masses, or tenderness and normal neurologic examination findings.