A 12-Year-Old Boy Is Brought to the Office for Evaluation

A 12-year-old boy is brought to the office for evaluation of intermittent dark urine and exertional fatigue for 2 weeks.  He has had no trauma, fever, muscle aches, dysuria, or urinary frequency or urgency.  The patient underwent aortic valve replacement with a mechanical valve for bicuspid aortic regurgitation a year ago, and he takes daily warfarin.  Temperature is 37.5 C (99.5 F) , blood pressure is 110/64 mm Hg, pulse is 98/min, and respirations are 16/min.  Cardiac examination reveals a regular rate and rhythm with crisp mechanical heart valve clicks.  Abdomen is soft and nontender.  There is no edema.  Urinalysis reveals the following: What is the best next step in management?

A) Cessation of warfarin with repeat urinalysis in 2 weeks
B) Complete blood count
C) Renal and bladder ultrasonography
D) Serum complement levels
E) Two sets of blood cultures from separate venipuncture sites
F) Urine culture

Correct Answer:

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