Case Study

摘要

An 8-year-old white girl is referred for evaluation of hematuria, proteinuria, and hypertension. She has had recurrent episodes of gross hematuria. The first was at 3 years of age and was attributed to a urinary tract infection, but a urine culture was negative. She was treated with 10 days of antibiotics, and the symptoms resolved. The second episode, at age 5 years, was attributed to acute poststreptococcal glomerulonephritis, although an antistreptolysin O (ASO) titer was normal, and complement studies were not ordered. Blood pressure at that time was 120/80 mm Hg (normal for age and height is 94/54 mm Hg). The girl was lost to follow-up and presents 3 years later with blood pressure at the 95th percentile, gross hematuria, and generalized edema. Urinalysis of tea-colored urine shows too-numerous-to-count dysmor-phic red blood cells (RBCs), white blood cells, proteinuria, and RBC casts. The differential diagnosis includes immunoglobulin A nephropathy, membranoproliferative glomerulonephritis, and hereditary nephritis, although the latter condition is unusual in a female. She is admitted for additional evaluation.