Key Symptoms and Presentation
The patient, a 6-year-old child, exhibits several critical symptoms:
- Oliguria: Reduced urine output.
- Haematuria: Presence of blood in the urine.
- Puffiness of face: Indicative of edema.
- Severe Hypertension: Blood pressure recorded at $200/100$ mm Hg.
- Convulsion: A sign of severe neurological compromise, likely due to hypertension.
Laboratory Findings Analysis
Reviewing the laboratory results:
- Complete Blood Count (CBC): Hemoglobin ($12$ g/dl), Total Leucocyte Count ($7200$/mm$^3$), and Platelet Count ($3.1$ lakhs/mm$^3$) are within normal limits for the age group. The normal platelet count is crucial as it helps rule out conditions like Haemolytic Uraemic Syndrome (HUS).
- Renal Function Tests: Blood Urea ($80$ mg/dl) and Serum Creatinine ($1.1$ mg/dl) are elevated, indicating impaired kidney function.
Differential Diagnosis Evaluation
Considering the options:
- Haemolytic uraemic syndrome is less likely due to the normal platelet count.
- Urinary tract infection typically does not present with such severe hypertension and hypertensive encephalopathy in this age group.
- Obstructive uropathy usually has a different clinical presentation and may not involve haematuria and acute hypertensive crisis as the primary features.
Most Likely Diagnosis Justification
The combination of findings strongly suggests Acute glomerulonephritis (AGN):
- AGN classically presents with the triad of haematuria, edema (puffiness), and hypertension.
- The severely elevated blood pressure ($200/100$ mm Hg) leading to a convulsion represents hypertensive encephalopathy, a serious complication of acute hypertension, often seen in AGN.
- The elevated blood urea and creatinine confirm acute kidney injury, consistent with glomerulonephritis.
Therefore, Acute glomerulonephritis with hypertensive encephalopathy is the most fitting diagnosis.
Important Questions from Nephrotic Syndrome
- All of the following conditions are associated with Glomerulonephritis with low complement level, EXCEPT:
- A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for low $C_3$ and increased titres of ASO and antiDNase. Which one of the following statements is NOT correct about management for this condition?
- Which of the following are the indications of Renal biopsy?
1. Chronic Kidney disease with normal sized kidney
2. Nephrotic syndrome in adults
3. Nephrotic syndrome in children with atypical features
Select the correct answer using the code given below: - Presence of Dysmorphic Erythrocytes in urine analysis is suggestive of:
A 40-year-old female with nephritic range proteinuria is found to have low serum complement levels. Which of the following can be the likely etiology?
1. Systemic lupus erythematosus
2. Post-infectious glomerulonephritis
3. Infective endocarditis
4. Mesangio-capillary glomerulonephritis
Select the correct answer using the code given below:
