Thrombotic microangiopathy Quiz: Ace Your Exams

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A 3-year-old boy presents to the emergency department for evaluation of abdominal cramps and malaise for four days. The parents became more concerned today when they noticed the patient was not urinating and was refusing to eat and drink. The patient was born full-term and is otherwise healthy. Vaccinations are up-to-date. Family history is significant for unexplained kidney disease in the parent. Temperature is 38.5°C (101.3°F), pulse is 101/min, respiratory rate is 22/min, blood pressure is 97/64 mm Hg, and oxygen saturation is 99% on room air. On physical examination, the patient appears pale, with poor skin turgor. Abdominal examination reveals generalized tenderness to palpation without rebound or guarding. Faint petechiae are noted on skin examination. Cardiopulmonary and neurologic examinations are unremarkable. Blood work is obtained with results as shown below. Peripheral blood smear demonstrates schistocytes. Coagulation profile is normal. Stool culture and testing is negative for Shiga toxin and shiga toxin-producing E coli. Which of the following studies should be performed next to confirm the diagnosis?

 CBC     Result    
 Hemoglobin     8.7 g/dL    
 Leukocyte count     12,100 /mm3    
 Platelet count     9,000/mm3    
 LDH     750 U/L     
 Haptoglobin     <83 mg/L    

 BMP     Result    
 Serum chemistry
 Sodium      131 mEq/L    
 Potassium      3.3 mEq/L    
 Chloride      97 mEq/L    
 Creatinine      2.7 mg/dL    

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