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A Chinese family immigrated to Canada in early 2008. One week after their arrival, the parents brought their nine-month-old son to the emergency department because of fever and unexplained crying. He refused solids, drank small amounts of a commercial iron-fortified formula and had few episodes of vomiting without diarrhea. His parents noticed that his urine was darker than normal with a strong smell, without macroscopic hematuria.
On physical examination, the infant was feverish but not toxic, and crying with slight pallor. He was not clinically dehydrated, and his blood pressure was 90/60 mmHg. The physician elicited suprapubic and left flank pain on palpation and questioned the possibility of a urinary tract infection. The laboratory test results revealed a white blood cell count of 9.0×109/L and a hemoglobin level of 95 g/L, and urinalysis revealed pyuria and microscopic hematuria. The child also had hypercalciuria. The urine culture obtained by catheterization confirmed an Escherichia coli infection; his blood culture was negative. The abdominal ultrasound revealed a left hydronephrosis, and a plain radiograph of the abdomen confirmed the presence of a radiopaque renal stone at the pelviureteric junction.
The parents were concerned and asked whether their son’s disease could be related to the outbreak of kidney disease stemming from melamine-contaminated milk in China.
The Canadian Paediatric Surveillance Program (CPSP) is a joint project of the Canadian Paediatric Society and the Public Health Agency of Canada, which undertakes the surveillance of rare diseases and conditions in children and youth. For more information, visit our Web site at <www.cps.ca/cpsp>