A diagnostic dilemma in a child with macroscopic hematuria, nephrotic syndrome and hypocomplementemia: Answers
In such a patient with nephritic and nephrotic components and hypocomplementemia, acute post-infectious glomerulonephritis (APIGN), particularly post-streptococcal glomerulonephritis (APSGN), is the first diagnosis to be considered. However, due to the lack of a history of upper respiratory tract infection or evidence for streptococcal infection, APIGN was initially excluded. The patient was diagnosed with C3 glomerulopathy (C3G) with a membranoproliferative pattern due to the light microscopy findings in addition to isolated C3 accumulation in IF.
Other pathologies including cryoglobulinemia, infective endocarditis, shunt nephritis, and lupus nephritis should also be considered in the differential diagnosis in addition to C3GN and APIGN. In our patient, cryoglobulinemia was excluded due to the absence of skin manifestations (ulcers or gangrene, livedo reticularis), vasomotor symptoms (Raynaud’s phenomenon and acrocyanosis), neurological symptoms, and/or musculoskeletal...
KeywordsChild Hematuria Nephrotic syndrome Hypocomplementemia C3 glomerulopathy Acute post-infectious glomerulonephritis APIGN
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Conflict of interest
The authors declare that they have no conflict of interest.
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