"SRH: it's not that simple!" a case report of a 16-year old with henoch schonlein purpura (HSP) who developed spontaneous renal hematoma (SRH) / Leo Paulo D. Angeles.

Includes appendices and bibliographical references.

ABSTRACT: The discussion o f the case highlights a 16-year old male who was brought in with a chief complaint of intermittent abdominal pain for 3 weeks associated with persistent purpuric rashes and bilateral joint pains. Henoch Schonlein Purpura (HSP) is not very common with the patient's age; hence, other diseases were entertained such as Systematic Lupus Erythematosus (SLE). In cases of patients having HSP or SLE, spontaneous renal hematoma (SRH) is a rare event. Locally, there are several causes of SRH, hence, several work-ups were done to help narrowing down its cause. Complete blood count showed leukocytosis with neutrophilic predominance, anemia and thrombocytosis. Urinalysis showed presence of pyuria, hematuria and proteinuria.Whole abdominal Ultrasound revealed presence of right renal hematoma and minimal ascites. Abdominal X-ray revealed segmental ileus and fecalimpaction. Renal Doppler Ultrasound was normal. Whole abdominal CT-scan revealed renal and perirenal hemorrhage.C-reactive protein and ESR were elevated. Serum electrolytes showed hyponatremia. ANA, C3 and fecal occult blood test (FOBT) were normal. BUN, Creatinine and Urine total protein/creatinine ratio were elevated. TPAG showed protein spillage. Chest x-ray revealed presence of Pneumonia. Hence, the diagnosis of Nephrotic-Nephritic Sydrome secondary to Henoch Schonelin Purpura (HSP); Subcapsular and Perirenal Hematoma, right; Pneumonia was made. The approach to the case was multidisciplinary, involving the pediatric nephrologist, cardiologist and haematologist, urologist and rheumatologist.

Research - Department of Child Health