Acute nephritis complicating Coxsackie B infection.

A 4-year-old Caucasian girl was admitted with a 4-day history of fever, diarrhea and vomiting, and 12-hs of oliguria. Her past medical history was negative for any renal disease. On admission, she had a temperature of 39.5oC and blood pressure of 93/48 mm Hg. Physical examination was normal. Investigations showed leukocytosis with 88% neutrophils and anemia (hemoglobin level of 8.7 g/ dL), elevated serum creatinine (3.84 mg/dL) and urea nitrogen (BUN) (164 mg/dL), estimated glomerular filtration rate (GFR) of 15.7 mL/min/1.73m2 and metabolic acidosis. Erythrocyte sedimentation rate was 61 mm at the end 1-hr and C-reactive protein was 22.5 mg/dL. Urinalysis showed 3+ proteinuria, hematuria with dysmorphic erythrocytes and red cells casts. Blood levels of electrolytes were normal. Urine, blood, stool and throat swab cultures were negative for pathogenic bacteria or fungi. Serum C3 and C4 complement levels, antistreptolysin O titer and autoantibodies were normal.