A 14-year-old patient came to the clinic with tiredness or fatigue, leg tremor, of 15 days' evolution. There was no history of fever, only morning cramps in the lower limbs in the previous days. Until then she had been dancing several days a week and led a very active life. Family originally from Chile. The child was born in New York and has lived in Spain for 6 years. Personal history not assessable. Correct vaccinations. No known drug allergies. No notable childhood illnesses. Menarche 2 years ago. Family history: relative with Berger's disease pending renal transplant.
Physical examination: weight 51 kg; height 160 cm; BP 120/80 mmHg; heart rate 105 beats/minute; axillary temperature 36.8 oC. Good general condition, pallor of skin and mucous membranes (blond), no skin lesions. Small submandibular adenopathies. Normal neurological examination; normal cardiorespiratory system; abdomen with no appreciable findings, no visceromegaly, negative lumbar percussion cuff; correct hydration.
Laboratory results
- Haemoglobin 10.3 g/dl; red blood cells 3,880,000; haematocrit 29.7; MCV 77; white blood cell count: 11,100 leukocytes with 63.2% neutrophils, 25.1% lymphocytes, 8.2% monocytes, 3% eosinophils and 0.5% basophils; platelets: 672,600/ml.
- Glycaemia 93 mg/dl with normal glycosylated haemoglobin; creatinine: 1.15 mg/dl; total cholesterol: 114 mg/dl; ferritin 133 mcg/l; sideremia 17 mcg/dl; bilirubin 0.29 mg/dl; alanine aminotransferase 8 U/l; aspartate aminotransferase 9 U/l; gamma-glutamyltransferase 12 U/l; triglycerides 62 mg/dl; TSH: 1.8093 mU/L (0.15-5.0).
Under suspicion of renal failure7,8 he was admitted to hospital. Renal ultrasound: kidneys symmetrical but significantly large; no dilatation of collecting systems, normal Doppler and normal echogenicity. Renal balance: GFR (T) 70.67 ml/min/1.73 m2; GFR (SC) 50.02 ml/min/ m2. Proteinuria 20.71 mg/m2/hour.
Diagnosis: mild to moderate renal failure with proteinuria without haematuria. Pathological diagnosis: tubulointerstitial nephritis with acute tubular damage (probably secondary to infectious process/drugs).