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A 13-year-old boy was admitted to the hospital because of headache, nausea, seizures, renal failure, and hypertension.
The patient had been well until approximately 3 weeks earlier, when intermittent left-sided headaches and fatigue developed, followed by nasal congestion and anorexia. He began to nap daily after school. During the week before admission, nausea and vomiting occurred approximately every other day. Five days before admission, facial and periorbital swelling developed. He saw his primary care physician. A test for streptococcal pharyngitis was reportedly negative; amoxicillin was prescribed for presumed sinusitis. He continued to feel unwell and was not as energetic as
Differential Diagnosis
Duration of Kidney Insufficiency
Causes of Nephritis
Rapidly Progressive Glomerulonephritis
The Hemolytic–Uremic Syndrome
Clinical Diagnosis
Dr. Michael J.G. Somers's Diagnosis
Pathological Discussion
Pathophysiology of the Hemolytic–Uremic Syndrome
Anatomical Diagnosis
Source Information
From the Division of Nephrology, Children's Hospital (M.J.G.S.); the Departments of Pediatrics (A.S.), Radiology (P.E.G., A.R.G.), and Pathology (E.E.S.), Massachusetts General Hospital; and the Departments of Pediatrics (M.J.G.S., A.S.), Radiology (P.E.G., A.R.G.), and Pathology (E.E.S.), Harvard Medical School — all in Boston.
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