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Clinical Case 9
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1

A 5 year-old boy presents for the evaluation of ‘red urine.’ He had a cold 2-3 days ago and the red urine was noticed this morning. His mom reports he had similar episodes 3-4 months ago and 6 weeks ago. The physician he saw at those times told the mother that he ‘didn’t find an infection.’ His mother reports his health has been good with the exception of hearing loss for which he was prescribed hearing aids 2 years previously. He had frequent ear infections as a child. The mother reports that the boy’s teen-aged brother has hearing loss requiring hearing aids as well. The boy’s father’s family history is unknown beyond the fact that a paternal uncle developed renal failure at 25 years of age. The boy’s physical examination is normal. Urinalysis shows 25-50 RBC, 1+ protein but no WBC or casts.

Which of the following statements is most correct?
A)Hematuria is due to a viral infection and is unlikely to have sequela. No further evaluation or intervention is indicated.
B)The boy likely has an x-linked-dominant hereditary nephritis. Progressive renal insufficiency is likely and family screening is indicated.
C)Post-streptococcal glomerulonephritis is most likely. The boy should be started immediately on high-dose penicillin.
D)The boy most likely has renal stone disease and should have a renal ultrasound and retrograde pyelogram immediately.
E)The boy most likely has benign familial hematuria, no further workup is indicated.





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