Case 148 -- Nephrotic Syndrome and Gross Hematuria

Contributed by Marie C. DeFrances, MD, PhD and Sheldon Bastacky, MD
Published on line in May 1998


PATIENT HISTORY:

The patient is a 20 year old white man who presented with nephrotic syndrome and gross hematuria associated with episodes of synpharyngitis. The patient was taking no medications. Review of systems revealed flank pain. On physical exam, blood pressure was 150/90.

LABORATORY DATA:

Creatinine - 1.3 mg%; BUN - 15 mg%; urine protein - 4.1 gm/day (4+ by dipstick); ANA negative; ASO - not performed; C3 - 107 mg/dl (normal - 75 - 140 mg/dl); C4 - 20 mg/dl (normal 4 - 36 mg/dl); C3 nephritic factor - 9% lysis (normal - <11 % lysis); urine sediment many RBCs and two RBC casts; urine culture not obtained; ultrasound kidneys bilaterally decreased in size.

MICROSCOPIC DESCRIPTION

IMMUNOFLUORESCENCE EXAMINATION

ELECTRON MICROSCOPIC EXAMINATION

FINAL DIAGNOSIS


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