PSGN with Gross Hematuria over a Year later

Hello,

It is common for urinary abnormalities to persist after PSGN. Three clarification questions:

1. When you say gross hematuria, do you mean frank blood or tea/cola colored urine?
   
2. Is your son's kidney function normal?
   
3. Did your son ever have a kidney biopsy?
   

Regards,

Jordan

1. Started as tea colored and now is bright red.
2. Yes normal kidney function
3. No biopsy

Thanks,

Did the urine color ever normalize after the initial bout? Secondly, did the change in urine color coincide with an upper respiratory tract infection (i.e. common cold)?

Jordan

Yes, after the initial bout his urine normalized (immediately after tonsillectomy was performed). It was normal for 10 months. I don't believe a respiratory tract infection coincined this time, but it is possible since his allergies were kind of bad this spring and I could've confused them with a cold. The hematuria has occurred daily for 2 weeks now. Several urinalyses have been ordered and everything looks fine except for RBCs are elevated, of course. He's been complaining a lot of stomach and head aches. Pediatrician doesn't think these aches are related and that hematuria will resolve soon. Blood pressure is also normal. Thoughts?

There would be a differential diagnosis here that would include other things besides PSGN, say for example, IgA nephropathy. If protein excretion is normal and as renal function is normal, the role for biopsy would be to clarify the diagnoses; treatment is likely not required. So waiting for the hematuria to resolve as your pediatrician has suggested would likely not result in any harm and may avoid a biopsy. Having said this, a consultation with a nephrologist would not be wrong and s/he could shed light with the help of a couple of additional lab tests. Two outstanding parameters would be to know urinary protein excretion and serum complement levels.

Thanks for your response. We are seeing a pediatric nephrologist next week. Based on my own research, I was wondering about IgA nephropathy. He is still experiering daily hematuria, it's been going on now for almost a month.