A Rare Cause of Necrotizing and Crescentic Glomerulonephritis in a Young Adult Male

Abstract

A 17-year-old white male adolescent presented to an rgent care provider for evaluation of worsening epistaxis. he primary care physician found no significant abnormaliies on physical examination, but screening laboratory tests howed a serum albumin level of 2.4 mg/dL (24 g/L). Spot rine creatinine and albumin levels were 140 mg/dL (12,376 mol/L) and 637 mg/dL (6.37 g/L), respectively. He was eferred for further evaluation of his proteinuria. He denied uch symptoms as lower-extremity edema, changes in urinaion, foamy urine, dysuria, hematuria, increased frequency, r urgency. He was physically active, running 3 to 4 miles very other day, and had not noted changes in exercise olerance. His review of systems had negative findings. His ast medical history included enuresis, encopresis, and hemauria as a child. A review of his pediatric records showed a istory of intermittent hematuria and low levels of intermitent proteinuria since the age of 3 years, with a normal renal ltrasound at the age of 7 years. He also had a history of ailing a school hearing evaluation at the age of 8 years; dditional testing had shown high-frequency sensorineural earing loss and a positive reflex decay in the right ear only evoked potentials were normal). There had been no folow-up audiometry evaluations. At the time of the initial evaluation, he had been precribed lisinopril for proteinuria and simvastatin for elevated holesterol and low-density lipoprotein levels, but had not tarted these medications yet. He had been taking an over-the-