iatroX Rounds #50
The clues
- 1
A 24-year-old man presents with visible blood in his urine that started this morning.
- 2
This episode of macroscopic haematuria developed within 48 hours of him starting to experience a sore throat and fever.
- 3
He recalls having a similar self-limiting episode of dark urine six months ago during a bout of gastroenteritis.
- 4
On examination his blood pressure is 154/96 mmHg, and there is no evidence of peripheral oedema or skin rashes.
- 5
Urinalysis shows 3+ blood and 1+ protein, while blood tests show a normal creatinine and normal C3 and C4 complement levels.
- 6
Renal biopsy demonstrates prominent mesangial hypercellularity and intense granular immunofluorescence staining for a specific immunoglobulin class within the mesangium.
<p>IgA nephropathy is the most common cause of primary glomerulonephritis worldwide [1]. It typically presents as synpharyngitic haematuria in young adults [1].</p>
- Visible haematuria following an upper respiratory tract infection [1].
- Synpharyngitic presentation occurring within 48 hours of infection onset [1].
- Mesangial expansion and immunoglobulin deposition on biopsy immunofluorescence [1].
for education and entertainment. not medical advice.