Hematuria in a 2-year-old Female

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Journal of Investigative Medicine





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Purpose of study Glomerulonephritis is a common renal disorder in paediatrics. The purpose of this case report is to discuss a unique case of post-infectious glomerulonephritis and provide physicians with the necessary knowledge to appropriately manage this condition to reduce complications associated with post-infectious glomerulonephritis. Methods used The patient’s medical charts and laboratory studies during the course of her hospital stay were reviewed for accuracy. Summary of results A 2-year-old previously healthy female child was admitted for hematuria. She has been having fever for the last 4 days with a recorded maximum temperature of 104 F. The parents report that she has been having multiple episodes of non-bloody non-bilious vomiting and bright red blood in urine for the last 2 days. She is on cefdinir which was started by her paediatrician two days prior to admission for a presumed urinary tract infection. Past medical and social histories were insignificant. On admission, she had a rectal temperature of 100.2 F and a heart rate of 126 beats per minute. Physical examination showed a non-toxic, dehydrated child and insignificant abdominal examination. She was noted to have a 2 cm by 4 cm impetiginous rash on her chin. Her CBC was within normal range. Urinalysis showed concentrated urine with 3+protein and 20 WBCs and >200 RBCs per high power field. Nitrite test was negative. Further work up revealed patient had elevated anti-streptolysin O (ASO) titers, low C3 protein and normal C4 protein levels suggesting post-streptococcal glomerulonephritis. Cefdinir was discontinued which we believe was responsible for the red-coloured stools. Conclusions A thorough history and physical examination are vital to identify the aetiology of glomerulonephritis. While glomerulonephritis can be asymptomatic, the classic presenting complaints are oedema and hematuria. After IgA nephropathy, the most common cause of glomerulonephritis is post-streptococcal glomerulonephritis (PSGN). This association between streptococcal infection and glomerulonephritis was noted more than 200 years ago in patients who had bloody urine following Scarlet fever. In addition to Group A Streptococci (GAS), there are many organisms and viruses that can also result in a similar clinical picture. Although this case report is a classic presentation of PSGN we believe it would be educational value to residents and physicians.


Medicine and Health Sciences



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