A teen patient is admitted to the hospital by his physician who suspects a diagnosis of acute glomerulonephritis. Which of the following findings is consistent with this diagnosis? Select all that apply.
A. Urine specific gravity of 1.040
B. Urine output of 350 ml in 24 hours
C. Brown (“tea-colored”) urine
D. Generalized edema
Correct Answer: A, B, & C
Acute glomerulonephritis is characterized by high urine specific gravity related to oliguria as well as dark “tea-colored” urine caused by large amounts of red blood cells.
Option A: The urine is dark. Its specific gravity is greater than 1.020. RBCs and RBC casts are present.
Option B: Functional changes include proteinuria, hematuria, reduction in GFR (ie, oliguria or anuria), and active urine sediment with RBCs and RBC casts. The decreased GFR and avid distal nephron salt and water retention result in the expansion of intravascular volume, edema, and, frequently, systemic hypertension.
Option C: This is a universal finding, even if it is microscopic. Gross hematuria is reported in 30% of pediatric patients, often manifesting as smoky-, coffee-, or cola-colored urine.
Option D: There is periorbital edema, but generalized edema is seen in nephrotic syndrome, not acute glomerulonephritis. Most often, the patient is a boy, aged 2-14 years, who suddenly develop puffiness of the eyelids and facial edema in the setting of a post-streptococcal infection.