Flank pain and gross hematuria: an uncommon presentation of a rare disease: Questions.
Flank pain and gross hematuria: an uncommon presentation of a rare disease: Questions.
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DOI：
10.1007/s00467-020-04889-6
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发表时间：
2021-07
期刊：
影响因子：
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通讯作者：
Yorgin PD
中科院分区：
文献类型：
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作者：
Allred ET;Yorgin PD
一名13岁，先前健康的男性，最初在急诊科就诊一周后出现深色尿液，没有任何相关的臀部或腹部疼痛、排尿困难或发烧。他的生命体征在可接受的范围内。实验室检测表明，3+血、4+蛋白和1+白细胞的棕色尿液，肌酸激酶升高至507U/L。他的全血细胞计数和综合代谢指标正常。他的发现被归因于横纹肌溶解，他接受了静脉输液，然后出院了。在家中，他的尿液恢复了正常，但大约两个月后，他再次出现了可口可乐色的尿液，这与双侧“背部骨盆疼痛”有关。这一次血尿持续了一周，这时他的初级保健医生要求患者进行肾脏超声检查，并将患者转至肾脏科。患者在去肾病科就诊期间没有症状，最初的检查包括补体(C3、C4)的正常部分、抗中性粒细胞抗体、双链DNA抗体、抗链溶血素滴度、凝血检查、尿钙/尿肌酐比率，以及抗中性粒细胞胞浆抗体阴性。他的尿液检测显示3+血和3+蛋白质，同时蛋白质与肌酐的比率升高至0.82。尿液镜检显示每个高倍视野有50-100个红细胞。他的肾脏超声
A 13-year-old, previously healthy male initially presented to the emergency department for one week of “dark-colored” urine without any associated flank or abdominal pain, dysuria or fevers. His vital signs were within acceptable range. Laboratory testing was significant for “brown” colored urine with 3+ blood, 4+ protein and 1+ leukocytes, along with an elevated creatinine kinase to 507 U/L. His complete blood cell count and comprehensive metabolic panel were normal. His findings were attributed to rhabdomyolysis and he was given intravenous fluids and discharged home. His urine returned to normal at home, but he again developed “Coca-Cola colored” urine about two months later that was associated with bilateral “pelvic pain at the back”. This episode of hematuria lasted for an additional week, at which point his primary care physician ordered a kidney ultrasound and referred the patient to Nephrology.The patient was asymptomatic during his visit with Nephrology with an initial work-up that included normal fractions of complement (C3, C4), antineutrophilic antibodies, double stranded DNA antibody, anti-streptolysin titer, coagulation studies, urine calcium/urine creatinine ratio, and negative antineutrophil cytoplasmic antibodies. His urine dip revealed 3+ blood and 3+ protein along with an elevated protein to creatinine ratio of 0.82. Urine microscopy revealed 50–100 red blood cells per high powered field. His kidney ultrasound