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A boy with fever, cough and gross haematuria
  1. Giorgio Cozzi,
  2. Massimo Maschio,
  3. Gabriele Poillucci,
  4. Marco Pennesi,
  5. Egidio Barbi
  1. Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
  1. Correspondence to Dr Giorgio Cozzi, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste 34137, Italy; giorgiocozzi{at}


A 5 year-old boy presented with 2-days of fever and cough. On examination, he had mild dyspnoea and chest pain, with crackles and hypoventilation at the right lung base. Blood tests showed: WBC 39.1×109/L; N 28.9×109/L; Hb 11.3gr/dL; PLT 375×109/L; CRP 28.7mg/dL; ESR 41mm/h. Chest x-ray confirmed a pulmonary consolidation in the right lower lobe (figure 1), with an associated pleural effusion. Bacterial pneumonia was diagnosed and intravenous ceftriaxone 100mg/kg/die was started. The following day, he developed palpebral oedema and his urine became tea coloured. His blood pressure was 126/82mmHg (>99th percentile).1 Serum creatinine rose from 0.45mg/dl to 1.09mg/dl (39.8µmol/L – 93.4µmol/L) and C3 was 9mg/dl (n.r. 90-180mg/dl). Urinalysis revealed gross hematuria and 3+ proteinuria, with microscopicy showing dysmorphic red blood cells with casts. Ultrasounds showed enlarged kidneys with increased echogenicity.

  • pneumonia
  • hematuria
  • glomerulonephritis

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  • Contributors GC, MM, GP, MP, EB contributed equally to the manuscript.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.