A 10-year-old male presented with headache, malaise, lethargy, loin pain, decreased urine output, and puffiness of the face; GUE: RBC cast ++, albumin ++; low C3 level and normal C4 level. Which of the following is TRUE about his disease?

Correct Answer: A

Rationale: The correct answer is A) acute nephritic syndrome. In this scenario, the clinical presentation and laboratory findings are consistent with acute nephritic syndrome. This condition is characterized by inflammation of the glomeruli in the kidneys, leading to hematuria, proteinuria, hypertension, and decreased renal function. The presence of RBC casts, albuminuria, low C3 levels, and normal C4 levels are typical findings in acute nephritic syndrome. Option B) nephrotic syndrome is incorrect because this condition is characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia, which are not the predominant features described in the case. Option C) acute renal failure is not the best choice as the clinical presentation in the question does not primarily suggest renal failure but rather an inflammatory process affecting the glomeruli. Option D) hypertension is a symptom commonly associated with acute nephritic syndrome due to fluid overload and renin-angiotensin system activation, but it is not the primary defining feature of the condition. In an educational context, understanding the differences between various renal conditions is crucial for nurses and healthcare providers. Recognizing the specific clinical manifestations, laboratory findings, and pathophysiology of each condition is essential for accurate diagnosis and appropriate management. This case highlights the importance of differentiating between acute nephritic syndrome and other renal disorders based on clinical presentation and laboratory results.

Correct Answer: D

Rationale: Plasmapheresis is a therapeutic procedure that involves removing blood plasma from the body and replacing it with fluids such as saline or albumin. In the context of pediatric genitourinary conditions, the correct answer, D) Goodpasture disease, is the most appropriate option for the use of plasmapheresis. Goodpasture disease is an autoimmune disorder characterized by the production of antibodies against the basement membrane in the lungs and kidneys, leading to glomerulonephritis and pulmonary hemorrhage. Plasmapheresis is beneficial in Goodpasture disease as it helps remove circulating autoantibodies and inflammatory mediators from the blood, thereby reducing the immune-mediated damage to the kidneys and lungs. Option A) post-infectious glomerulonephritis is typically managed with supportive care and treatment of the underlying infection, rather than plasmapheresis. Option B) immunoglobulin A nephropathy and Option C) Henoch-Schönlein purpura are immune complex-mediated renal diseases where plasmapheresis has not shown significant benefit compared to other treatment modalities like corticosteroids and immunosuppressants. Educationally, understanding the appropriate use of plasmapheresis in different pediatric genitourinary conditions is crucial for nurses and healthcare providers working in pediatric settings. This knowledge ensures that interventions are evidence-based and tailored to each specific condition, ultimately improving patient outcomes and safety.

Correct Answer: D

Rationale: In the treatment of diarrhea-associated hemolytic-uremic syndrome, the option that has no beneficial role is red cell transfusions (Option D). The correct answer is D because red cell transfusions do not address the underlying cause of hemolytic-uremic syndrome, which is primarily related to kidney damage secondary to the release of toxins from certain strains of E. coli bacteria. Transfusions do not remove these toxins or treat the kidney damage. Option A, dialysis, is beneficial in managing the complications of kidney failure that can occur in hemolytic-uremic syndrome. Option B, early intravenous volume expansion, helps maintain adequate renal perfusion and prevent further kidney damage. Option C, controlling hypertension, is important as high blood pressure can worsen kidney function. In an educational context, understanding the rationale behind each treatment option is crucial for nurses and healthcare providers caring for pediatric patients with hemolytic-uremic syndrome. This knowledge can guide appropriate interventions, improve patient outcomes, and prevent potential complications. It also highlights the importance of evidence-based practice in pharmacological management.

Correct Answer: C

Rationale: Rationale: Correct Answer: C) Hemolytic-uremic syndrome Sickle cell nephropathy refers to kidney damage in individuals with sickle cell disease. Clinical manifestations of sickle cell nephropathy can include hematuria (blood in the urine), renal tubular acidosis (a condition where the kidneys are unable to maintain the correct balance of acids in the body), and polyuria (excessive urination). Option A: Hematuria is a common clinical manifestation of sickle cell nephropathy due to the damage to the kidney's blood vessels. Option B: Polyuria can occur in sickle cell nephropathy as the kidneys may struggle to concentrate urine properly. Option D: Renal tubular acidosis is seen in sickle cell nephropathy due to the impaired acid-base regulation by the kidneys. Option C: Hemolytic-uremic syndrome, while a serious condition involving abnormal destruction of red blood cells, is not typically a direct clinical manifestation of sickle cell nephropathy. It is more commonly associated with bacterial infections or certain genetic factors. Educational Context: Understanding the clinical manifestations of sickle cell nephropathy is crucial for healthcare providers caring for pediatric patients with sickle cell disease. Recognizing these signs and symptoms can aid in early detection and management of kidney complications in these individuals, ultimately improving patient outcomes. It is important for nurses, nurse practitioners, and other healthcare professionals to be knowledgeable about the various complications associated with sickle cell disease to provide comprehensive care to pediatric patients.

Correct Answer: A

Rationale: In the context of pediatric pharmacology, understanding urine dipstick measurements is crucial for assessing renal function. In this case, the correct answer is A) very high urine pH (>7.0) because alkaline urine can lead to a false-negative protein result on a urine dipstick. Proteins are amphoteric molecules, meaning they have both acidic and basic groups. In an alkaline environment, proteins tend to ionize and lose their characteristic reactivity with the dipstick, resulting in a false-negative reading. Option B) large volume of urine output is incorrect because the volume of urine output does not directly impact the accuracy of protein measurement on a dipstick. Option C) contamination of the urine with blood is also incorrect as blood contamination would likely cause a positive result for blood rather than affecting protein measurement. Option D) highly concentrated urine specimen is incorrect because concentrated urine would typically lead to a false positive rather than a false negative protein result. Educationally, this question highlights the importance of understanding how different factors such as pH can influence urine dipstick results. It reinforces the need for healthcare providers to consider various variables that can impact test outcomes when interpreting results in pediatric patients. This knowledge is vital for nurses, pharmacists, and other healthcare professionals who care for pediatric patients and need to accurately interpret diagnostic tests.