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- Arslan Arshad, MD
- Carmen M. Taveras, MD
- Tazuddin Mohammed, MD
- Gerard Prosper, MD
- Lincoln Medical and Mental Health Center, Bronx, NY
- Magda Mendez, MD
- Lincoln Medical and Mental Health Center, Bronx, NY, and Weill Cornell Medical College, New York, NY
- Mohammed Alsheikh-Ali Absi, MD
- Dima Turpin, MD
- Umar Boston, MD
- Le Bonheur Children’s Medical Center, Memphis, Tenn.
- Heather M. Taylor, MD
- University of Alabama, Tuscaloosa, Ala.
- Javier Valero-Fonseca, MD
- Vanderbilt University, Nashville, Tenn.
Author Disclosure
Drs Arshad, Taveras, Mohammed, Prosper, Mendez, Alsheikh-Ali Absi, Turpin, Boston, Taylor, and Valero-Fonseca have disclosed no financial relationships relevant to these cases. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Case 1 Presentation
A 16-year-old boy presents with 3 days of pain on urination and bloody discharge at the end of urination. There is no history of fever, sore throat, rash, bloody diarrhea, trauma, medication intake, recent bladder catheterization, easy bruisability, sexual activity, or sickle cell disease. The family history is negative for hematuria, renal disorders, or deafness.
On physical examination, the boy is alert and in no distress. All vital signs are normal. His weight is 92.8 kg (>97th percentile), height is 168 cm (10th percentile), and body mass index is greater than the 95th percentile. The rest of the findings are within normal limits.
During initial laboratory investigation, urinalysis shows 10 to 15 eumorphic red blood cells (RBCs)/high power field (hpf), 2 to 5 WBCs/hpf, and a positive test for leukocyte esterase. He is treated with trimethoprim-sulfamethoxazole and asked to return for follow-up.
The urine culture as well as gonorrhea and Chlamydia screening tests sent at the initial evaluation are negative. His dysuria persists, and he experiences another episode of gross hematuria. The physical examination findings remain unchanged. A repeat urinalysis shows 30 to 50 eumorphic RBCs/hpf. Serum electrolyte and creatinine concentrations are normal, urine creatinine is 401.7 mg/dL (35,510.3 mcmol/L), urine calcium concentration is 14.4 mg/dL (3.6 mmol/L) (urine calcium-to-creatinine ratio, 0.03), prothombin time is 11.90 seconds, activated partial thromboplastin time is 32.5 seconds, international normalized ratio is 0.98, Hgb is 12.9 g/dL (129 g/L), and platelet count is 275×103/mcL (275×109/L). Serum concentrations of complement C3 and C4 and antistreptolysin A (ASO) titer are normal. An additional …
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