Raju, a five-year-old boy, suffering from glomerulonephritis. Which of the following finding is associated with this condition?

Appeared in: JSSH Staff Nurse - 2019

Explanation

Glomerulonephritis involves inflammation of the kidney's filtering units, the glomeruli.
This inflammation increases the permeability of the glomerular capillaries, allowing red blood cells (RBCs) to pass into the urine, a condition known as hematuria.
The presence of these RBCs, particularly when they break down, gives the urine a characteristic smoky brown, tea, or cola-like color.
This finding is a hallmark sign of acute glomerulonephritis.

Option A: In glomerulonephritis, the kidneys' ability to filter is reduced, often leading to decreased urine output (oliguria). This causes the urine to become more concentrated, resulting in a HIGH specific gravity, not low.
Option B: Glomerulonephritis impairs the kidneys' function of filtering waste products from the blood. This leads to the accumulation of nitrogenous wastes, causing an ELEVATED Blood Urea Nitrogen (BUN) level, a condition known as azotemia.
Option D: The decreased filtration in glomerulonephritis leads to the retention of sodium and water. This increase in fluid volume within the circulatory system results in HYPERTENSION (high blood pressure), not hypotension.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical manifestations of acute glomerulonephritis (AGN) in children as background academic context rather than a clinical decision trigger.
A primary nursing responsibility for a child with AGN is frequent and accurate blood pressure monitoring, as hypertension can lead to severe complications like seizures and encephalopathy.
Strict monitoring of fluid intake and output, along with daily weight checks, is crucial to manage fluid overload, edema, and hypertension.
Assessing urine for color, clarity, and amount helps in monitoring the progression or resolution of the disease.

How to Approach the Question

First, identify the core diagnosis in the question stem: 'glomerulonephritis'.
Recall the basic pathophysiology of this condition: inflammation of the glomeruli leads to decreased filtration, but increased permeability to large molecules like proteins and red blood cells.
Think through the consequences of this pathophysiology: a) RBCs in urine cause a color change; b) Decreased filtration leads to fluid retention and waste product buildup.
Evaluate each option based on these consequences:
Does it cause low specific gravity? No, fluid retention and oliguria cause high specific gravity.
Does it cause low BUN? No, decreased filtration causes high BUN.

Concept Tested & Keywords

Concept Tested: Clinical manifestations of acute glomerulonephritis (AGN) in children.
Stem keywords: five-year-old boy, glomerulonephritis, finding
Lead-in keywords: Which of the following
Clinical cues: Diagnosis of glomerulonephritis is the key to identifying associated symptoms.
Negative lead-in flag: false

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 489-491

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

Practise the full JSSH Staff Nurse - 2019

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