USMLE Step 1 Question 348

Question:

A 4 year old boy is brought in by his mother after she discovers that his urine is now a dark coca-cola color. She reports that he was at the doctor 10 days ago because he was complaining of a sore throat, but he has otherwise been well. What is the most likely diagnosis?

Correct Answer: E.  Post-streptococcal glomerulonephritis

The history of possible streptococcal pharyngitis and lack of other symptoms makes post-streptococcal GN the most likely answer.

(B) Goodpasture’s does not typically present before young adulthood and results in destruction of pulmonary and glomerular basement membranes.

(C) HSP is a vasculitic syndrome that often includes purpura, abdominal pain, and arthritis. Glomerulonephritis is often seen.

(D) Minimal change disease is a nephrotic syndrome. The primary complaint of dark colored urine and recent possible streptococcal infection makes a nephritic syndrome more likely.