Nephrology Q25

A 27-year-old woman is evaluated for a 6-month history of fatigue, arthralgia, and myalgia. She has a history of urinary tract infections. Medications are an oral contraceptive pill and as-needed naproxen for pain.

On physical examination, temperature is 38.2 °C (100.8 °F), blood pressure is 142/90 mm Hg, and pulse rate is 90/min. Cardiac, lung, and abdominal examinations are normal.

Laboratory studies show a serum creatinine level of 1.4 mg/dL (123.8 µmol/L); urinalysis shows 2+ blood, 3+ protein, positive leukocyte esterase, no nitrites, 10-15 erythrocytes/hpf, 5-10 leukocytes/hpf, and no crystals.

Urine microscopy is shown.

Which of the following is the most likely diagnosis?

Urinary tract infection

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