8 yr old child with BP 180/100 minhg, urea 90, creatinine 5.3, urinalysis shows 15-20 pus cells, 12 RBC, protein 1+ & has no significant past h/o of similar complaint. Most likely diagnosis isaEUR'
Chronic interstitial nephritis with VUR Information provided in the question:- Hypeension ARF (increased urea and creatinine) Pvuria, Absence of hematuria Mild proteinuria These features suggest chronic interstitial disease with vesicoureteric reflux. -Vescioureteric reflux in children may leas to chronic interstitial nephritis. - In children chronic interstitial disease commonly occurs as a result of underlying congenital renal disease such as obstructive uropathy or vesicoureteric reflux. - Presence of urinary tract infection due to vesicoureteric reflux explains the presence of pus cells on urinanalysis. - Hypeension is common in chronic interstitial nephritis. - Proteinuria in chronic intersititial disease is mild < 1.5/day. Post infective ,elomeru lo n ep h ri t is Absence of hematuria and presence mild proteinuria rules out post infective glomerulonephritis. Hetnaturia is universal in patients with post infective glomeru- lonephritis. It is always accompanied by significant proteinuria. Accelarated hypeension with acute renal failure Accelarated hypeension with acute renal failure cannot explain the presence of pus cells on urinanalysis. Idiopathic RPGN Idiopathic RPGN also does not explain the presence of pus cells on urinanalysis.
Post infective glomerulonephritis
Accelerated hypeension with ARF
Idiopathic RPGN
Chronic interstitial nephritis with VUR