A 5-year-old boy presents with gross hematuria ('tea-colored' or 'cola-colored' urine), facial puffiness, and mild hypertension 2 weeks after an episode of culture-confirmed streptococcal pharyngitis. Serum complement C3 is markedly decreased. What is the diagnosis?

Answer and explanation

Correct answer: B. Post-streptococcal glomerulonephritis (PSGN)

  1. Step 1: Analyze post-infectious timeline: Acute nephritic syndrome occurring 1 to 3 weeks following streptococcal pharyngitis (or 3 to 6 weeks following impetigo).
  2. Step 2: Evaluate clinical manifestations: Hematuria (cola-colored urine), edema, hypertension, and transient low complement C3 levels reflect immune complex deposition.
  3. Step 3: Conclude diagnosis: Acute post-streptococcal glomerulonephritis (PSGN).
Answer
Post-streptococcal glomerulonephritis (PSGN).
Why not the others: 'Minimal change disease' causes pure nephrotic syndrome with normal C3; 'Alport syndrome' is an X-linked type IV collagen disorder with sensorineural deafness; 'Polycystic kidney disease' presents with flank masses and cysts on ultrasound.

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