Renal Case: 22-year-old Woman with Tea-colored Urine

00:01 Let's move to another clinical case.

00:03 We have a 22-year-old woman who presents to her primary care provider with new-onset tea-colored urine that developed during an upper respiratory infection.

00:12 She has no medical problems and only takes oral contraceptive pills.

00:16 Her physical exam is relatively unremarkable and her creatinine is normal at 0.73 mg/dL, and her urinalysis shows numerous red blood cells, at least 50% of them on microscopic review have dysmorphic features.

00:31 She also has a spot urinary albumin-to-creatinine ratio that estimates about 1.5 g of protein.

00:38 She has no serum complement abnormalities so she has a normal C3 and C4 complement in her blood.

00:44 She otherwise feels relatively well.

00:46 So, what is the most likely etiology of her renal presentation? Let's go through it and take a look, and see if we can answer that question.

00:54 So, some of the important things to really note is that she notes tea-colored urine.

01:00 When a patient talks about either tea-colored urine or cola-colored urine, that's very suggestive of gross hematuria, meaning that you can see blood in urine with a naked eye.

01:11 She also mentioned that this occurred during an upper respiratory infection.

01:17 That's a term that we call synpharyngitic hematuria and it's almost pathognomonic for something like IgA nephropathy.

01:25 Now, let's look at our labs.

01:27 She's got numerous RBCs and 50% of them have dysmorphic features.

01:32 Again, along with that proteinuria, that subnephrotic range, that really makes us think about nephritic syndrome.

01:39 So, very suspect for some kind of glomerulonephritis.

01:42 Taken together, her most likely etiology is IgA nephropathy.