Question of the Week #11 – Archer USMLE Step 3

A 7-year-old boy is brought to the emergency department by his mother because of “tea-colored urine” for the last several days. He has also had some nausea and vomiting, and his eyes appear swollen when he wakes up in the morning. The eye swelling tends to resolve over the course of the day. He is generally very healthy and there is no family history of any chronic diseases. His temperature is 36.7 C (98.0 F), blood pressure is 130/90 mm Hg, pulse is 96/min, and respiratory rate is 16/min. Physical examination is unremarkable. A urinalysis shows red cell casts. At this time the most appropriate study to confirm your diagnosis is

A. antinuclear antibody
B. antistreptolysin O antibody
C. renal biopsy
D. renal ultrasound
E. urine culture

5 Responses

  1. Based on tea colored urine, RBC casts and edema (possibly proteinuria) its likely one of the many Nephritic syndromes, which can be confirmed with Renal Biopsy (C).

  2. I think it is B.

  3. What is the official answer?

  4. i also think b. Clinically he has Glomerulonephritis. Most common cause for this in children is post strep. If we find evidence that he had strep infection by means of ASO titers it is enough. Renal biopsy is invasive

  5. B

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