A child was diagnosed with acute post streptococcal glomerulonephritis and renal insufficiency. Which laboratory result will the nurse expect to note in the child?

Appeared in: DHS 2018 shift 1st

Explanation

The question links the diagnosis of acute post-streptococcal glomerulonephritis (APSGN) with the complication of renal insufficiency.
Renal insufficiency is defined by the kidney's reduced ability to filter metabolic waste products from the blood.
Blood Urea Nitrogen (BUN) and Creatinine are the primary metabolic waste products filtered by the kidneys.
When kidney function is impaired (renal insufficiency), BUN and creatinine are not adequately excreted and their levels rise in the blood.
Therefore, elevated BUN and creatinine levels are the most direct and expected laboratory findings indicating renal insufficiency.

Option A: This is incorrect because glomerular inflammation in APSGN damages the filtration barrier, leading to increased permeability and the leakage of protein into the urine (proteinuria). A negative result would be highly unexpected.
Option B: This is incorrect as hematuria (presence of Red Blood Cells) is a classic, hallmark sign of glomerulonephritis. The inflammation causes damage to the glomerular capillaries, allowing RBCs to pass into the urine.
Option C: While an elevated White Blood Cell (WBC) count can indicate inflammation or a recent infection (like the preceding strep infection), it is not a specific marker for renal insufficiency. The question specifically asks for a result related to impaired kidney function.

Clinical Relevance

Nursing practice connection: Use the key finding related to Laboratory findings in Acute Post-streptococcal Glomerulonephritis (APSGN) with renal insufficiency to guide bedside assessment, documentation, and the next nursing action.
For a nurse, monitoring BUN and creatinine levels is a critical responsibility in caring for a child with APSGN, as it directly reflects the severity and progression of kidney injury.
A sharp rise in these values indicates worsening renal insufficiency and may necessitate more aggressive interventions, such as dialysis, and stricter dietary restrictions (protein, sodium, potassium, fluids).
Patient safety depends on recognizing these changes early to prevent life-threatening complications like uremia, severe hyperkalemia (which can cause cardiac arrhythmias), and fluid overload.

How to Approach the Question

First, break down the question's stem. Identify the patient (a child) and the two key diagnoses: 'acute post-streptococcal glomerulonephritis' and 'renal insufficiency'.
Recognize that the question is asking for a laboratory finding that specifically reflects 'renal insufficiency'.
Define 'renal insufficiency' in your mind: It's the kidney's failure to adequately filter waste products from the blood.
Think about the standard lab tests used to measure kidney filtration function. Blood Urea Nitrogen (BUN) and Creatinine are the primary markers.
Evaluate each option based on this understanding:
Options A and B suggest the absence ('Negative') of proteinuria and hematuria. You should know that these are characteristic findings of glomerulonephritis, so their absence would be incorrect.

Concept Tested & Keywords

Concept Tested: Laboratory findings in Acute Post-streptococcal Glomerulonephritis (APSGN) with renal insufficiency.
Stem keywords: acute post streptococcal glomerulonephritis, renal insufficiency, laboratory result, child
Lead-in keywords: expect to note
Clinical cues: Diagnosis of both glomerulonephritis and renal insufficiency indicates both glomerular damage and impaired kidney function.
Negative lead-in flag: false

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1047-1049

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 496-498

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.