A 14 year old malay male from Malacca was admitted in ward 3-3 Malacca GH 3 days ago with the chief complaints of facial puffiness and passing smokey urine for 1 week. The facial puffiness initially started off as periorbital oedema which then progressed to involve the entire face within a week. It was noticed to more in the mornings if compared to the rest of the day. The urine was high colored (smokey) and the urine was also frothy. Urinary output was also decreased. There is no dysuria, hematuria and increased frequency of micturation.He also complaint of fever for one week which was of low grade, intermittent with no chills and rigor. He also experienced headaches which was more at night just before he sleeps. There is also presence of an erythmatous scaly itchy circular skin lesion on his right elbow which was first noticed 2 weeks back. There is no history of sore throat, flu, blood transfusion, nausea, and vomiting, rashes, dyspnoea and chest pain. There is no significant past medical and surgical history. His mother has asthma and hypertension. He is a smoker for the past 2 years and smokes 3-4 sticks a day. No history of alcohol consumptions, IVDU, sexual promiscuity, and allergies.
General examinations revealed pallor, high blood pressure of 139/96 mmHg, and an erythmatous scaly circular skin lesion on his right elbow. Abdomen, respiratory, cardiovascular, and central nervous system were unremarkable. Urine biochemistry revealed protein 3+, RBC 4+. Blood urea was raised to 500 umol/L. ASOT titres were still unavailable. Other parameters were within normal range. Coming to the conclusion of this case, the most appropriate diagnosis would definitely be acute nephritic syndrome.
Acute nephritic Syndrome is characterized by azotemia, hypertension, oedema, hematuria, proteinuria and oliguria. Salt and water retention are due to reduced GFR and may result in circulatory congestion. RBC casts under urine microscopy will confirm the diagnosis. Most from of acute nephritic syndrome are mediated by humoral immune mechanism. Clinical course depends on the underlying disease.