A 7-year-old boy is brought to the emergency department by his mother because of “tea-colored urine” for the last several days. He has also had some nausea and vomiting, and his eyes appear swollen when he wakes up in the morning. The eye swelling tends to resolve over the course of the day. He is generally very healthy and there is no family history of any chronic diseases. His temperature is 36.7 C (98.0 F), blood pressure is 130/90 mm Hg, pulse is 96/min, and respiratory rate is 16/min. Physical examination is unremarkable. A urinalysis shows red cell casts. At this time the most appropriate study to confirm your diagnosis is
A. antinuclear antibody
B. antistreptolysin O antibody
C. renal biopsy
D. renal ultrasound
E. urine culture
Copy Rights: Archer USMLE Reviews
D.
answer B ( post streptrococal glomeruonephritis)
B. antistreptolysin O antibody,
to rule out post step. nephritis
Answer B
B
B
b
b
its bbbbbbbb
b
C. Renal biopsy
the only confirmatory test in the list.
indicated inGN with hematuria
C. Renal biopsy
the only confirmatory test in the list.
indicated in GN with hematuria
I’d like to go with B.
c
CCCCCCCCCCCCCCCCCCCCCCC
I’ll go with c, the renal biopsy. ASO is useful but not 100% sensi and only provides possible clue of association, not the diagnosis-the pathology
C is the answer
It seems a like presentation for PSGN so I would expect the RBCS ,hypertension,facial swelling and +anti-strep antibody but i expect a HX of URI -GI infection
I also do agree with NOOK seeing is believing !
biopsy
C. renal biopsy
B. antistreptolysin O antibody
Consider renal biopsy only in presence of acute renal failure, nephrotic syndrome, negative streptococcal test or normal complement or if present for more than 2 months after onset.
Renal biopsy
- minimal change disease.
Why ASO? No history of soar throt, exudate or adenopathy..
Renal biopsy
In a differential of nephritic (includes PSGN, IgA, SLE, Goodpastures) versus Nephrotic (minimal change disease, membranous) the nephritic has proteinuria, hematuria and the nephrotic has severe proteinuria (>3.5gm/dL) edema, hypoalbuminemia (this could cause eye swelling) and hyperlipidemia (incidentally there too). Only renal biopsy can distinguish causes of nephrotic syndrome, so this is really a great question. most likely is minimal change disease..note that PSGN (ASO titer positive and low compliment) usually occurs 7-10 days after hematuria, while IgA appears in 2 days but these are both nephritic.. Good thoughtful clinically relevant.
Mr medicine man.. This is a case of Nephritic on Nephrotic syndrome! You do not differentiate nephritic vs nephrotic. Although, biopsy is correct for an adult for a confirmation. In children, when there’s proteinuria you must start with a course of steroids and in this case the only positive finding is RBC casts, so it is best to do ASO titre if there’s no clear history as to wether the child had an infection or not. Your right this may be IGA nephropathy which appears in 2 days but it’s always best to rule out PSGN with an ASO titre before doing a Renal biopsy in a child.
You are absolutely right. Also, here is a nephritic syndrome, with hematuria, not nephrotic, so, it points to glomerulonephritis, which is not the case with minimal change disease or nephrotic syndrome. So checking ASO titre is definitely the most reasonable next step.
Although Renal Biopsy is the answer for confirmation of diagnosis because ASO titre is not that specific, you never do a renal biopsy in a child. You always start with a course of steroids. On the contrary, if this were an adult then biopsy is the correct answer.
Dr Red please explain this
Answer is C to differentiate between nephritis /nephrotic synd.
renal biopsy,,,,even if it be PSGN for confirm the diagnosis biopsy should be done and ASO could not confirm the diagnosis
guys, what is the dfinitive or the correct answer?