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A previously healthy 16-year-old boy was referred for a 3-day history of gross haematuria without pain or other symptoms. Family history was negative for renal disease or hearing loss. Physical examination showed a tall and slim boy, blood pressure was 112/68 mm Hg, heart rate was 58/min, there was no oedema and the body weight was referred as stable.
Remarkably, during the observation period, the boy passed alternately dark reddish and light pink urine; urinary output was normal (1.2 mL/kg/hour).
Urine dipstick showed haematuria (4+) with proteinuria (2+). Repeated microscope urine analysis showed erythrocytes with both glomerular and postglomerular appearance, without casts.
Laboratory tests, including creatinine, C3, C4, electrolyte, serum albumin, immune-globulins, cholesterol and triglycerids, were normal, while autoantibodies (anti-neutrophil cytoplasmic antibodies, antinuclear antibodies and anti-DNA) and antistreptolysin O were negative. Proteinuria in 24-hour urine collection was quantified as 4 g (normal values <150 mg/24 hours). Renal ultrasonography showed normal kidneys and bladder, without stones. A CT scan of his abdomen was performed (figures 1 and 2).
Contributors MP, IR and RP identified and managed the case. EB conceived the manuscript. All the authors have been involved in drafting the manuscript and revising it critically and have given final approval of the version to be published.
Competing interests None declared.
Patient consent Parental/guardian consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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