Scenario of Oliguria, Peri-Orbital Puffiness & Red Colored Urine

Scenario of Oliguria, Peri-Orbital Puffiness & Red Colored Urine

Scenario of Oliguria, Peri-orbital Puffiness & Red Colored Urine

A 6 years old boy presents with oliguria, peri-orbital puffiness and red colored urine. He had skin infection 3 weeks ago. His bp is 145/100 mmHg.

  1. What is most likely diagnosis?
  2. Which points prove your diagnosis?
  3. How will you investigate this patient?
  4. Name important complications of this disease.

Diagnosis

Acute post streptococcal glomerulonephritis (APSG)

Diagnostic Points

  • The patient has the history of skin infection.
  • Oliguria, peri-orbital puffiness and red colored urine point towards renal disease.
  • Red colored or cola colored urine is the characteristic feature of APSG.

Acute post streptococcal glomerulonephritis is associated with red colored or cola colored urine due to hematuria or present of blood in the urine.

Investigations

  • Urine complete examination (U/E) shows proteinuria usually less than 200 mg/dl.
  • Blood examination shows raised ESR, c reactive protein (CRP) and decreased HB.
  • Serum electrolytes shows hyponatremia and hyperkalemia.
  • Complement level is decreased.
  • Renal functions test (RFTs) shows increased urea and creatinine levels.
  • Throat swab, raised ASO titer and streptozyme enzyme for evidence of streptococcal infection.
  • X-ray chest may reveal peri-hilar infiltrates of pulmonary edema associated with this infection.
  • Renal biopsy in rare cases

C reactie protein (CRP) should be sent to confirm the presence of infection in childrens.

Complications

Important complications are:

  • Anuria / oliguria
  • Left ventricular failure
  • Hypertensive encephalopathy

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Scenario of Oliguria, Peri-Orbital Puffiness & Red Colored Urine

Scenario of Oliguria, Peri-Orbital Puffiness & Red Colored Urine