8 yr old child with BP 180/100 mm Hg, urea 90, creatinine 5.3, urinalysis shows 15-20 pus cells, l2 RBC, protein 1-1- & has no significant past h/o of similar complaint. Most likely diagnosis is?
Ans is 'd' i.e., Chronic interstitial nephritis with VUR o This child is having: (i) Elevated BP (Hypeension) (ii) Elevated BUN (90) and Creatinine (5.3) -*ARE (iii) 15-20 Pus cells --> Pyuria (iv) No hematura (1-2 RBC) ---> for microscopic hematuria to be significant, 5-10 RBCs/j.iL of urine are required (v) Minimal proteinuria (1 +) o Post-infective glomerulonephritis and idiopathic RPGN have significant hematuria as they present as nephritic syndrome. So, these options are ruled out. o Accelerated hypeension with ARF cannot explain the presence of pyuria. So, this option is alos excluded. o Now we are left with option d. vesicoureteric reflux in children may cause chronic interstitial rephritis. Chronic interstitial nephritis may have all the features given in the question: (i) Hypeension is common ARF may occur in VUR (iii) Pyuria is common due to recurrent infection Proteinuria in chronic interstitial disease is mild (
Post infective glomerulonephritis
Accelerated hypeension with ARF
Idiopathic RPGN
Chronic interstitial nephritis with VUR