Strep A

A 13-year-old boy presented to the clinic complaining of a sore throat that persisted for 2 days. After those 2 days, he developed fever, nausea, and malaise. A throat culture revealed the presence of group A beta-hemolytic streptococci, and the child was started on antibiotic therapy. The child’s symptoms gradually improved, but approximately 2 weeks later, he returned to the clinic because the fever, nausea, and malaise returned. He became tachypneic and short of breath. The mother noted that his eyes were puffy, his ankles were swollen, and his urine was dark and cloudy. 

On examination, the child’s blood pressure was 148/100 mmHg; his pulse 122 beats per minute; and his respirations were 35 per minute. Orbital and ankle edema were present. Crackles were auscultated bilaterally. No heart murmurs were found. Slight tenderness to percussion over the flank areas was noted. 

A chest X-ray showed evidence of congestion and edema in the lungs. The patient’s hematocrit was 37%, and his WBC count was 11,200/mm3. Blood urea nitrogen was 48 mg/dL (normal is less than 20 mg/dL). Urinalysis results showed that the patient’s protein was 2+ (24-hour excretion was 0.8 g), specific gravity was 1.012, and there were moderate amounts of RBCs and WBCs in the urine. Serum albumin was 4.1 g/dL (normal is 3.5–4.5). 

  1. Which evidence supports the conclusion that this patient has a kidney disease?
  2. Which clinical pattern of kidney disease does this patient have? Explain the symptoms.
  3. Which morphologic changes would you expect in the kidney?
  4. What is the prognosis?
  5. What are the possible short- and long-term complications of this disease?
  6. Is it necessary to hospitalize the patient?