Case Presentation – Syndromes


A 12-year-old male presents to the clinic with a complaint of dark-colored urine for the past week. His mother reports that he had a sore throat approximately three weeks ago, which was treated symptomatically at home. The patient also mentions a reduction in urine output over the past few days and has felt increasingly tired.

Past Medical History:

  • No significant past medical history
  • No known allergies
  • Up-to-date with vaccinations

Family History:

  • No family history of kidney disease

Social History:

  • Lives at home with parents
  • Attends school regularly, no recent travel history

Examination Findings

On physical examination, the patient appears moderately ill with the following findings:

Vital Signs:

  • Temperature: 36.8°C
  • Blood Pressure: 150/95 mmHg
  • Heart Rate: 90 bpm
  • Respiratory Rate: 18 breaths per minute

General Appearance:

  • Periorbital edema
  • Mild pitting edema in both lower extremities

Cardiovascular Examination:

  • Normal heart sounds, no murmurs
  • Elevated jugular venous pressure

Respiratory Examination:

  • Clear breath sounds bilaterally

Abdominal Examination:

  • No organomegaly
  • No tenderness on palpation

Urine Examination:

  • Dark-colored urine sample provided

Laboratory Findings

Key laboratory investigations reveal:


  • Hematuria: Numerous red blood cells (RBCs) per high power field (hpf)
  • Red cell casts present
  • Proteinuria: 1.5 g/day

Blood Tests:

  • Serum Creatinine: 1.8 mg/dL (elevated)
  • Blood Urea Nitrogen (BUN): 40 mg/dL (elevated)
  • Serum Albumin: 3.5 g/dL (normal to low)
  • Anti-streptolysin O (ASO) Titer: Elevated
  • Complement C3: Low
  • Complete Blood Count (CBC):
  • Hemoglobin: 12 g/dL
  • White Blood Cells (WBC): 10,000 cells/mm³
  • Platelets: 200,000 cells/mm³

Serologic Tests:

  • Antinuclear Antibody (ANA): Negative
  • Antineutrophil Cytoplasmic Antibodies (ANCA): Negative
  • Anti-Glomerular Basement Membrane (Anti-GBM) Antibodies: Negative


Renal Ultrasound:

  • Kidneys are bilaterally enlarged with increased echogenicity


Based on the clinical presentation, laboratory findings, and radiologic imaging, the diagnosis of nephritic syndrome, likely secondary to post-streptococcal glomerulonephritis, is made.

Differential Diagnosis

  • IgA nephropathy
  • Lupus nephritis
  • Henoch-Schönlein purpura
  • Goodpasture syndrome
  • Membranoproliferative glomerulonephritis (MPGN)


Initial Management

  • Blood Pressure Control: Antihypertensives (ACE inhibitors or ARBs)
  • Fluid Management: Diuretics to manage edema
  • Dietary Restrictions: Sodium and fluid restriction

Specific Treatment

  • Antibiotics: To eradicate any residual streptococcal infection if present
  • Steroids: Considered in severe cases or if rapidly progressive glomerulonephritis is suspected


  • Regular monitoring of renal function, blood pressure, and proteinuria
  • Repeat urinalysis and serologic tests as needed


Nephritic syndrome is a potentially serious condition requiring prompt diagnosis and management. Early recognition, appropriate laboratory evaluation, and targeted treatment are essential for optimal patient outcomes. Regular follow-up is necessary to monitor disease progression and prevent complications.

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