Renal Case: 28-year-old Man with Cola-colored Urine

by Amy Sussman, MD

My Notes
  • Required.
Save Cancel
    Learning Material 2
    • PDF
      Slides Nephritic Syndrome.pdf
    • PDF
      Download Lecture Overview
    Report mistake

    00:01 Let's move on to our next clinical case.

    00:03 A 28-year-old man presents to his primary care provider for new onset cola-colored urine.

    00:09 In questioning him further, he recalls a terrible sore throat a few weeks ago that resolved with some antibiotics he was given at the urgent care center.

    00:19 On physical exam, he's noted to have an elevated blood pressure at 147/90 mmHg which is new for him.

    00:25 He was lower-extremity edema and periorbital edema.

    00:28 His serum creatinine is high at 1.9 mg/dL and his urine analysis shows numerous red blood cells and he also has white blood cells in there as well.

    00:39 Nearly all of those red blood cells, when looking underneath the microscope, showed dysmorphic features and he actually has 2-3 red blood cell cast per high power field.

    00:48 On a urinary spot albumin-to-creatinine ratio, it estimates about 2 g per gram of albumin.

    00:54 So, estimating about 2 g of protein excretion with a 24-hour period of time.

    00:59 He has a low serum complement C3 but he has a normal serum complement C4.

    01:05 So, what is the etiology of this patient's renal presentation? Let's see if we can find some clues in our case.

    01:13 So, one of the things that is important to note, he has cola-colored urine.

    01:17 When people describe tea or cola-colored urine, remember, that really is a symptom or sign of gross hematuria.

    01:26 Hematuria or blood cell seen with a naked eye.

    01:29 The other thing that's really important is he's describing an infection, an upper respiratory infection, in particular, a sore throat.

    01:38 But that happened weeks ago before the onset of the tea-colored urine.

    01:42 So, that temporal correlation is important.

    01:44 It's not synpharyngitic like it was with our IgA nephropathy.

    01:48 He had the sore throat first, treated with antibiotics, and now, he's manifesting with a tea-colored urine.

    01:56 That's more indicative of a post-infectious glomerulonephritis.

    02:01 The other thing which is important, he's got some signs of nephritic syndrome with his elevated blood pressure.

    02:07 Again, those dysmorphic RBCs. He is volume overloaded or hypertensive.

    02:13 Again, he's got that periorbital edema. And his laboratory values.

    02:19 So, he's got an elevated creatinine, he's got those dysmorphic-looking red blood cells, and I think the clincher here is we have a low C3 complement and a normal C4.

    02:30 That is an alert to us telling us that the alternative pathway of complement activation is being turned on and there's only a couple of things that we need to think about with that.

    02:38 We're either thinking about complement mediated MPGN or something like infection-associated GN and in fact, that's what this gentleman has, post-infectious or infection-associated GN.

    About the Lecture

    The lecture Renal Case: 28-year-old Man with Cola-colored Urine by Amy Sussman, MD is from the course Nephritic Syndrome.

    Included Quiz Questions

    1. Temporal relation to an infection
    2. High blood pressure
    3. Cola-colored or tea-colored urine
    4. Puffy eyes and lower limb edema
    5. Urine output of less than 400 mL/24 hours

    Author of lecture Renal Case: 28-year-old Man with Cola-colored Urine

     Amy Sussman, MD

    Amy Sussman, MD

    Customer reviews

    5,0 of 5 stars
    5 Stars
    4 Stars
    3 Stars
    2 Stars
    1  Star