When obtaining history for acute onset renal dysfunction with fatigue, oliguria, and coffee-colored urine, which finding would be significant?

• A. Recent streptococcal infection
• B. History of hypertension
• C. Recent trauma
• D. Allergies

Answer: (A)

A recent streptococcal infection is the most significant finding because it points to post-streptococcal glomerulonephritis, a nephritic process that often follows a throat or skin infection. Immune complexes formed in response to the infection deposit in the glomeruli, causing inflammation, reduced filtration, and leakage of red blood cells into the urine. This produces the fatigue and oliguria seen with acute kidney dysfunction, and the coffee-colored urine reflects hematuria. The typical time frame of about one to three weeks after the infection makes this link particularly likely in the history.

A history of hypertension might raise concern for kidney disease generally, but it does not on its own explain an acute onset of renal dysfunction with dark urine after a recent infection. Recent trauma could suggest kidney injury, but the presentation would usually be centered around injury characteristics and pain. Allergies are not related to this nephritic process.