MKSAP: 25-year-old man with dark-colored urine
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old man is evaluated for dark-colored urine for 2 days, swelling of the face and hands for 1 day, and severe headaches this morning. He reports having an upper respiratory tract infection 1 week ago with fever, sore throat, and swollen glands, but had otherwise felt well. Medical history is otherwise unremarkable, and he takes no medications.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 180/90 mm Hg, pulse rate is 88/min, and respiration rate is 14/min. Cardiopulmonary and abdominal examinations are normal. No skin rash or arthritis is present. There is bilateral lower extremity edema to the mid shins.
Laboratory studies:
Albumin
3.3 g/dL (33 g/L)
C3
Low
C4
Normal
Creatinine
1.4 mg/dL (124 µmol/L)
Antistreptolysin O antibodies
Elevated
Urinalysis
3+ blood; 2+ protein; too numerous to count erythrocytes/hpf; 10-15 leukocytes/hpf; numerous erythrocyte casts
Urine protein-creatinine ratio
1900 mg/g
Rapid streptococcal antigen test
Positive
Which of the following is the most likely diagnosis?
A. IgA nephropathy
B. Infection-related glomerulonephritis
C. Lupus nephritis
D. Small-vessel vasculitis
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Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Infectious Disease Nephrology Source Type: blogs
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