Timmy, an 8-year-old male, presents to his family doctor with a progressively worsening sore throat of 2 day’s duration.

Timmy, an 8-year-old male, presents to his family doctor with a progressively worsening sore throat of 2 day’s duration. His other symptoms consist of headache, malaise, loss of appetite, abnormal taste, soreness in his neck, and difficulty swallowing. He is particularly distressed by his sore throat. Physical exam reveals a temperature of 101.2 F, tender cervical lymphadnopathy, tonsillar swelling and exudate without any other symptoms. Timmy doesn’t like swallowing pills and decides to see if he will improve on his own without the use of antibiotics. And he does. His sore throat resolves and he feels better. But, approximately 20 days after his initial symptoms he notices new symptoms that include dark “cola colored” urine, facial puffiness and abdominal pain for the past 2 days. He is experiencing nonspecific abdominal pain that comes and goes and does not seem to be related to eating or bowel movements. There is no nausea or vomiting. His urine is dark brown and he has not been voiding as much as usual, only 2 times in the past 24 hrs. There is no urinary frequency, urgency, dysuria or foul smell to the urine. His appetite has been poor although he is still drinking fluids