Pediatrics
A 3-year-old girt is brought to the Emergency Department with fever and dark urine.
Her parents state that she had been cons7pated. On examina7on, she looks unwell and irritable with abdominal tendemess, but no palpable liver or spieen (see lab results). Blood pressure 125/86 mmg Heart rate 125 min Respiratory rate 29 /min Temperature 39.9° C Test Result Normal Values WBC 16.5 4.5-10.5 x 109/L Hb 81 112-160 g/L Platelets count 325 150-400 x 109/L Urinalysis Test Result Normal Values Leukocytes 16 0-3 per high power field Erythrocytes 18 0-2 per high power field Protein ++ Absent Which of the foilowing is the most appropriate management?
الشرح
Core Concept: Acute glomerulonephritis in a child presents as the nephritic syndrome — haematuria, proteinuria, hypertension and salt-and-water retention. The immediate management is restriction of salt and fluid, because the hypertension is volume-driven.
Clinical Presentation:
- Dark ('cola-coloured') urine, oedema and hypertension: 125/86 mmHg is far above the 95th centile for a 3-year-old and is the finding that must be acted on.
- Urinalysis with red cells, white cells and proteinuria; anaemia from haemodilution and the acute illness.
Diagnosis:
- First-line: urinalysis with microscopy for dysmorphic red cells and red cell casts, urine protein/creatinine ratio, serum creatinine and electrolytes, complement C3 and antistreptolysin O titre.
- Renal biopsy is reserved for an atypical course — persistent low C3, progressive renal failure or nephrotic-range proteinuria.
Management:
- Acute: salt and fluid restriction is the foundation, with a loop diuretic added for significant volume overload and antihypertensives for severe hypertension.
- Definitive: supportive care with monitoring of blood pressure and renal function; antibiotics treat a residual streptococcal focus but do not alter the glomerular injury, and corticosteroids have no role in typical post-infectious glomerulonephritis.