Nephritic syndromes (pediatrics) Quiz: Ace Your Exams
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A 6-year-old boy presents to the emergency department along with his parents for evaluation of altered mental status and decreased urine output for the past 12 hours. The parents report tea-colored urine and swelling around the eyes that gradually progressed to involve the entire face. There has been no fever, rash, or recent viral illness. The child has a history of systemic lupus erythematosus (SLE) diagnosed 4 years ago, with no follow-up for the past 6 months due to relocation. Family and surgical histories are noncontributory. Temperature is 37°C (98.6°F), pulse is 110/min, respirations are 22/min, blood pressure is 125/80 mm Hg, and oxygen saturation is 97% on room air. The child appears sleepy and is oriented to self but not to time or place. Periorbital and lower extremity edema are noted. Initial laboratory results are shown below. Which of the following is the immediate next step in management?
| Serum chemistry | |
| Hemoglobin | 10.9 g/dL |
| White blood cells | 7,600 / mm3 |
| Platelets | 95,000 / mm3 |
| Serum creatinine | 1.9 mg/dL |
| Blood urea nitrogen (BUN) | 35 mg/dL |
| Potassium | 4.9 mEq/L |
| Urine | |
| Erythrocytes | 60/hpf |
| Leukocytes | 2/hpf |
| Urine specific gravity | 1.010 |
| Protein | +3 |
| Red blood cell casts | Positive |
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