Acute renal failure and tubular necrosis associated with hematuria due to glomerulonephritis

A 16 year old male with a history of recurrent synpharyngitic macroscopic hematuria presented with severe loin pain, macroscopic hematuria and oliguric acute renal failure. Although renal biopsy showed mesangial IgA nephropathy with focal and segmental proliferation with crescents, the extent of glomerular involvement could not explain the severe functional disturbance. Intratubular obstruction and tubular necrosis secondary to the presence of severe glomerular bleeding provide a better explanation. Although renal failure resolved spontaneously, the long-term effects of episodes of this type on structure and function is unknown.