Sir.—The recent article by Welch et al1 describing five children with rapidly progressive IgA nephropathy prompted us to report the following case.
Patient Report.—A 16-year-old girl presented with a two-week history of headache, nausea, and blurred vision. Her medical history was significant for idiopathic mental retardation, cerebral palsy, and recurrent urinary tract infections. Episodes of gross hematuria or symptoms suggestive of Henoch-Schönlein purpura were denied. Three years earlier, a blood pressure of 100/70 mm Hg and proteinuria (3+) had been noted; results of an intravenous pyelogram and voiding cystourethrogram performed at that time were normal.
Examination revealed an anxious, confused girl with a blood pressure of 240/160 mm Hg. Bilateral grade IV hypertensive retinopathy was present. Urinalysis showed proteinuria (4+) without red blood cells. Urine protein excretion was 5.3 g/d. Her serum creatinine concentration was 133 μmol/L, and the albumin concentration was 22 g/L. Serum complement levels