Case 15-1994: A 14-Year-Old Girl with Newly Recognized End-Stage Renal Failure

Presentation of Case A 14-year-old girl was admitted to the hospital because of biochemical features of advanced renal failure. The patient had been apparently well and active until two months earlier, when she began to experience fatigue after exercise, increasing lethargy, and occasional epistaxis. Four weeks before admission muscle cramps developed in the legs and often awakened her. Two weeks before entry a pediatrician found no abnormality except for slight proteinuria and a mixed bacterial flora in the urine. During the several days before admission her breathing became “labored.” On the day of admission laboratory studies were performed at another . . .