You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information.
What is A child presents with brown colored urine and oliguria for last 3 days. He has mild facial and pedal edema. His blood pressure is 126/90. He has +3 proteinuria with 100 red cell and a few granular casts. His creatinine is 0.9, urea is 56. What is his diagnosis? and explain in detail?
Ans. (a) PSGNRef: Nelson Text book of Pediatrics 20th Ed; Page No-2498 & Ghats Essential Pediatrics 9th Ed; Page No-469* Most common cause of glomerulonephritis is immune mediated injury caused by Immune complexes and glomerular antigen mediated damage. It is characterized by the triad of hematuria, azotemia and hypertension.* The most common cause of acute glomerulonephritis is that following streptococcal infection (PSGN-Post streptococcal Glomerulonephritis).Post streptococcal Glomerulonephritis (PSGN)* Acute post streptococcal Glomerulonephritis is caused by autoimmune injury only due to selective nephritogenic strains of streptococcus.* The patient develops glomerulonephritis with streptococcal pharyngitis usually in winter after 1-2 weeks of infection and with streptococcal pyoderma in summer after 3-6 weeks of infection.* Nephritogenic strains include types 4 and 12 (pharyngitis) and type 49 (pyoderma).Clinical Features:* The most common age o presentation is 5-12 years (school- age children) and is rarely seen before 3 years of age.* The onset is rapid, with puffiness around the eyes and pedal edema.* The patient presents with gross hematuria with smoky, cola or tea colour urine and hypertension.* Peripheral edema typically results from salt and water retention.* Complications that can be seen are hypertensive encephalopathy, pulmonary haemorrhage, cerebral vasculitis, hyperkalemia, hypophosphatemia and acidosis.Diagnosis* Light microscopy: Proliferation of endothelial & mesangial cells* Fluorescence: Ig G, Ig M, and C3 deposits in mesangium.* RBCs casts on urine analysis is a characteristic feature* Urine shows 1-2+ proteinuria* Elation ASO titer (In skin infection ASO titre remains normal-here elevated anti-DNAse B titers help in diagnosis).Management* The treatment is usually suppurative most of the cases resolves spontaneously and rarely my progress to renal failure.* Close monitoring of blood pressure and diet (should be low in sodium and potassium).* Fluid restriction.* Diuretics (e.g. frusemide) for edema.* Penicillin is usually given for infection however it does not alter the course of glomerulonephritis.* Antihypertensive drugs (Amlodipine, nifedipine or diuretics); hypertensive emergencies need treatment with IV nitroprusside or labetalol.