The urine examination of a child with acute glomerulonephritis shows?

DSSSB -28 August 2019 (Shift-2)

Child Health Nursing (Pediatrics)

Easy

Appeared in: DSSSB -28 August 2019 (Shift-2)

Explanation

Acute glomerulonephritis (AGN) involves inflammation and damage to the glomeruli, the kidney's filtering units.
This damage allows red blood cells to leak from the blood into the urine (hematuria).
As these red blood cells travel through the nephron, the acidic environment of the urine oxidizes the hemoglobin.
This process changes the color of the urine from fresh red to a characteristic smoky brown or cola-color.
The presence of red blood cell casts on microscopy confirms the glomerular origin of the bleeding.

Option A: In AGN, the kidney's ability to filter waste is reduced, often leading to oliguria (decreased urine output). This causes the urine to become more concentrated, resulting in an increased, not decreased, specific gravity.
Option B: A classic sign of the acute phase of glomerulonephritis is oliguria, which is a significant decrease in urine output. This is due to the inflammation reducing the glomerular filtration rate (GFR).
Option D: Bright red urine indicates fresh, unaltered blood. This is characteristic of bleeding in the lower urinary tract (e.g., bladder, urethra, or from a kidney stone) where the blood does not have time to become oxidized.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Urinalysis Findings in Acute Glomerulonephritis as background academic context rather than a clinical decision trigger.
A nurse's assessment of urine characteristics (color, clarity, amount) is a critical, non-invasive tool for monitoring disease progression and kidney function in a child with AGN.
Accurate intake and output monitoring is essential to manage fluid balance, detect oliguria, and prevent complications like fluid overload, hypertension, and edema.
What if? If a child with known AGN suddenly develops complete anuria (no urine output), it is a medical emergency. The nurse must immediately notify the physician as this could indicate rapidly progressive glomerulonephritis or acute renal failure, requiring urgent intervention.

How to Approach the Question

First, identify the core concept of the question, which is the clinical presentation of acute glomerulonephritis (AGN) in a child, specifically the urine findings.
Recall the basic pathophysiology of AGN: inflammation of the glomeruli leads to damage and leakage of red blood cells into the renal tubules.
Think about what happens to blood as it travels through the acidic environment of the nephron. The hemoglobin will oxidize.
Deduce the resulting urine color. Oxidized blood is brown, not bright red. This points to 'Brown colour urine' as the likely answer.
Evaluate the other options based on AGN pathophysiology. Glomerular inflammation impairs filtration, leading to decreased urine output (oliguria), not increased. This decreased output concentrates the urine, leading to increased specific gravity, not decreased. This confirms the other options are incorrect.

Concept Tested & Keywords

Concept Tested: Urinalysis Findings in Acute Glomerulonephritis
Stem keywords: urine examination, child, acute glomerulonephritis
Lead-in keywords: shows
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

QUlbBILgoiK-PYzjLctnHB

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

E6 Medicine Harrison 22e Part 2 p. 284-286