Pediatric IgA Nephropathy Insights, Immunoglobulin A (IgA) Nephropathy, Glomerulonephritis: Causes,

Описание: A 13-year-old boy presents in late winter with sudden onset cola-colored urine, periumbilical pain, and palpable purpura after a recent upper respiratory infection. His history includes episodic hematuria following similar infections, mild ankle pain, and persistent proteinuria. What clinical findings and laboratory clues should guide your diagnostic approach in this pediatric glomerular disease case? How do you distinguish this presentation among various causes of glomerulonephritis?

VIDEO INFO
Category: Pediatric IgA Nephropathy Insights, Immunoglobulin A (IgA) Nephropathy, Glomerulonephritis: Causes, Diagnosis, and Management, Nephrology: Kidney Disease Diagnosis and Management
Difficulty: Hard - Advanced level - Challenges experienced practitioners
Question Type: Diagnosis - Identify conditions based on clinical presentation
Case Type: Rare Presentation

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QUESTION
A 13-year-old boy is admitted in late winter for cola-colored urine noted the morning after two days of sore throat, nasal congestion, and low-grade fever. He reports crampy periumbilical pain without vomiting or diarrhea and mild aching of both ankles worse with walking. Similar brief episodes of visible hematuria have occurred since age 10, typically starting within 24-48 hours of upper-respiratory symptoms and resolving within a week, with months of microscopic hematuria between flares....

OPTIONS
A. IgA vasculitis nephritis (pediatric IgA vasculitis with kidney involvement), given palpable purpura with IgA/C3 on skin immunofluorescence, synpharyngitic gross hematuria, normal complement, dysmorphic erythrocytes with red blood cell casts, subnephrotic proteinuria, and supportive abdominal find...
B. Primary IgA nephropathy without systemic vasculitis, assuming the skin findings are unrelated; this would not integrate biopsy-proven IgA deposition in dermal vessels with leukocytoclastic vasculitis concurrent with renal sediment indicative of glomerulonephritis in a child.
C. Infection-related (post-streptococcal) immune-complex glomerulonephritis, presuming occult streptococcal pharyngitis with a 1-3 week latency and low C3, despite the short 24-48 hour timing and documented normal complement at presentation.
D. C3 glomerulopathy driven by alternative pathway dysregulation, proposing complement-mediated disease despite persistently normal C3/C4, absence of dense-deposit features, and lack of complementopathy pointers in history or examination.

CORRECT ANSWER
A. IgA vasculitis nephritis (pediatric IgA vasculitis with kidney involvement), given palpable purpura with IgA/C3 on skin immunofluorescence, synpharyngitic gross hematuria, normal complement, dysmorphic erythrocytes with red blood cell casts, subnephrotic proteinuria, and supportive abdominal findings; manage on a pediatric pathway with blood pressure and proteinuria control.

EXPLANATION
This child s presentation is dominated by synpharyngitic gross hematuria within 24-48 hours of a mucosal infection, red blood cell casts with dysmorphic erythrocytes (including acanthocytes), normal complement, subnephrotic proteinuria, and classic extrarenal features of small-vessel IgA vasculitis (palpable purpura on dependent areas, abdominal pain, ankle arthralgia). Critically, the calf skin biopsy demonstrates leukocytoclastic vasculitis with granular IgA and C3 deposition, which clinches the systemic vasculitic phenotype....


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