April 11, 2009

12 years old boy with tea colored urine

A 12 years old boy presented with tea colored urine 4 weeks after developing sore throat with 20 cents coin size swelling on his neck. According to the mother, the sore throat relief without any medication and she did not bring his son to the hospitals. He also complains of back pain which develop 3 days ago. A dipstick test was perform and the result shown below.

Protein: 2+

Glucose: nil

Bilirubbin: nil

Blood: 4+

Image taken from lecture note “The Face in Medicine” by Dr. Izham Cheong, FRCP, Professor of Medicine, UNIVERSITI KEBANGSAAN MALAYSIA

1) Describe the abnormality observe in the above picture (2m)

2) What is your provisional diagnosis (2m)

3) Name one clinical signs that you wants to look for(1m)

4) List three investigation that you would like to perform to confirm the diagnosis (3m)

5) Outline the microscopy findings in this disease (2m)


1) Preorbital edema

2) Acute post streptococcal glomerulonephritis

3) Hypertension


a) Blood investigation

- Blood urea and nitrogen

- Serum creatinine

- Blood culture

b) Serology

- Anti GBM Ab

- Compliment levels

c) Others

- Renal biopsy

5) Microscopic findings include

- Diffuse involvement

- Glomerulus enlarge and edematous

- Increase cellularity.

Normal vs post streptococcal glomerulomephritis

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Ya Allah! Permudahkanlah aku untuk menuntut ilmuMu, memahaminya, mengingati dan menyebarkannya. Berkatilah ilmu itu dan tambahkanlah ia. Amin.