Subjective Data
Personal Particulars
Initials: B.W
Age: 14 years
Gender: male
Race: African American
Chief Complaint
Flank pain and lower limb swelling for one week
History Of The Presenting Complaint
The patient was brought in by his father who reports flank pain bilaterally that was of gradual onset. The pain is dull in nature and has been increasing every day since its first onset. The pain is not radiating. It increases during voiding and on exertion. It is relieved by taking analgesics or resting. It is associated with generalized body weakness, mild headache, and fever. Episodic Visit: Genitourinary Condition Focused Note.The patient complains of bilateral lower limb swelling that has been of gradual onset from the ankle joint had has now progressed to the mid-thigh. The father reports that the child wakes up with facial puffiness in the morning which disappears in the course of the day. B.W reports that his urine color has changed to dark brown and reduced urine output. However the patient denies urine incontinence, dribbling, poor urine stream, and hesitancy
Episodic Visit: Genitourinary Condition Focused Note.
Past Medical And Surgical History
The patient reports no previous history of admission, blood transfusion, and surgical procedure. However, his father reports that during his childhood he had had frequent infections of tonsillitis and sinusitis. There is no history of chronic illnesses and no known history of food and drug allergy.Episodic Visit: Genitourinary Condition Focused Note.
Personal Social-Economic And Family History
The patient is a high school student who stays with his parents and other two siblings. He is the firstborn in his family. His performance in school is brilliant both academically and in extra-curricular activities. He relates well with other students, teachers, siblings, and his parents. He is from a well-up family. His father is hypertensive and his mother has connective tissue disorder. He denies drinking alcohol and indulging in drugs and substances.Episodic Visit: Genitourinary Condition Focused Note.
Review Of Systems
The affected system is the genital urinary system where the patient presents with flank pain, hematuria, oliguria, lower limb edema, and morning facial puffiness. The cardiovascular system is not affected, however, the patient presents with lower limb edema and generalized body malaise. There is no history of palpitation, shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and syncope. Respiratory, gastrointestinal, and musculoskeletal systems have no presenting symptoms.Episodic Visit: Genitourinary Condition Focused Note.
Objective Data
General Examination
The patient looks sickly, oriented to time, place, and person. He has generalized pitting edema from the ankle joint to the sacral region and periorbital edema. The edema is pitting and non-tender. The patient has no pallor, lymphadenopathy, dehydration, and cyanosis. His vitals are blood pressure slightly at 141/91mmHg, the pulse rate at 78beats per minute, the temperature at 37.8 degrees Celcius, and oxygen circulation at 99% room air.Episodic Visit: Genitourinary Condition Focused Note.
Systemic Examination
Systemic examination was done when the patient is lying in the supine position. Upon inspection, the abdomen is distended with flank fullness, moving with respiration, there is no mass, and the skin color is normal. Upon palpation, there is flank tenderness bilaterally. The kidneys are not palpable. There is shifting dullness and fluid thrill on percussion.
Diagnostic Investigation
Laboratory workups help in making an accurate diagnosis. For this patient, urinalysis, complete blood count, renal function test, serum electrolytes, c-reactive proteins, antistreptolysin O Titre (ASOT), autoantibodies(ANA, ANCA, anti-ds-DNA), and blood cultures (Tavares, et al, 2020). Urinalysis results show proteinuria and the presence of red blood cells. Complete blood count shows elevated white blood cells and lymphocytes. Hemoglobin levels are reduced (microcytic and hypochromic). The renal function test shows elevated creatinine levels and the glomerular filtration rate is reduced. Antistreptolysin O titer is positive.Episodic Visit: Genitourinary Condition Focused Note.
Assessment
Differential Diagnosis
Differential diagnoses are acute glomerulonephritis, acute kidney injury, and n
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