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ABSTRACT
We present the case of a 29-year-old type 1 diabetic patient with the diagnosis of acute post-streptococcal glomerulonephritis. The incidence of this textbook example of acute glomerulonephritis has dropped dramatically in the developed world during the past decades due to the more widespread use of antibiotics. However, the present case illustrates that it is not an extinct disease and that clinicians should be aware of this entity. Particular attention is needed for the fact that the clinical context in which the disease occurs may be different from the classical "post-angina" presentation.
Key words: acute kidney injury, glomerulonephritis, post-infectious, post-streptococcal anti-biotics
CASE REPORT
A 29-year-old male patient, with a medical history of type 1 diabetes mellitus, diabetic retinopathy and arterial hypertension, was sent to the emergency department. One month before, he spent his holidays in a diving resort in Egypt, where he crushed the third finger of the right hand. Some days later, the fingertip got swollen. He didn't search medical attention. Two weeks later, upon arrival in Belgium, he developed a redly coloured, painful swelling of the leftthigh, which had initiated as a small pustule. His general practitioner noticed subcutaneous abcedation and treated by drainage of pus and antibiotics (amoxicillin-clavulanate 4 g a day). A few days before the current admission, still on antibiotics, he noticed swelling of his ankles and hands, upon which he was sent for further investigation.
His home therapy consisted of 4 subcutaneous injections of insulin daily, valsartan 160 mg and amlodipine 10 mg.
Clinical examination at time of presentation revealed a blood pressure of 219/90 mmHg and a pulse frequency of 116 beats per minute. Body temperature was at 36.0 degrees Celsius. Both feet and arms showed pitting edema. Further systematic clinical examination was normal.
Laboratory tests are summarized in Table 1. Protein electrophoresis showed a polyclonal gammopathy. Hemoglobin A1c was 84 mmol/mol (9.8%). Urine analysis showed 44 white blood cells per µL and 140 red blood cells per µL (of which 88% were dysmorphic). Proteinuria on urine sample was 3.54 g/g creatinine (24 hour proteinuria: 5.43 g/24h). It is of note that one year before the current admission, his serum creatinine was 1.20 mg/dL.
Abdominal ultrasound showed some ascites and bilateral pleural effusion. There were no...