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 Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Infectious Disease Nephrology Source Type: blogs