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Abstract

In September, 2003, a 9-year-old female Indian child was referred for evaluation of persistent microscopic haematuria, abdominal pain, and chronic fatigue of 18 months duration. Physical examination was normal, her kidneys were not palpable and there were no signs of systemic diseases. Urinary dipstick test showed blood 4+. There were 40 RBC per high power field with no dysmorphic cells. There was no protein in the urine, osmolality was 1010 mOsm/kg and pH 6. Repeated urinary cultures were negative. Renal function was normal and there was no evidence of orthostatic proteinuria. Laboratory tests for blood dyscrasias (including sickle cell disease), infections, autoimmune diseases, tumours, and metabolic disorders were negative. Iron studies were normal. Renal biopsy showed 35 glomeruli with mild increase in cellularity. Tubular luminal red blood cells were also present. There was no significant interstitial inflammation, tubular atrophy, or vascular changes. Spikes and double contours were not shown on special stains, making membranoproliferative or membranous glomerulonephritis unlikely. Immunofluorescence was negative and electronmicroscopy did not show features of thin basement membrane disease or Alport syndrome. The biopsy features were reported as being consistent with a resolving glomerulonephritis.