A 8 years old child with BP 180/100 mm Hg, Blood Urea 90 mg/dl, creatinine 5.3 mg/dl, urinalysis shows 15-20 pus cells, 1-2 RBC, protein 1+; Most likely diagnosis is:
d. Chronic interstitial nephritis with VUR(Ref: Nelson's 20/e p 2537, Ghai 8/e p 483)In the given clinical scenario, child has hypertension, renal failure (increased urea and creatinine), pyuria, absence of hematuria (presence of 5RBCs/HPF is considered significant) and mild proteinuria, Out of the options given, Chronic Interstitial Nephritis with VUR seems most appropriate diagnosis.Chronic Interstitial diseaseIn children, it commonly occurs as a result of underlying obstructive uropathy or VURPresence of urinary tract infection due to VUR explains the presence of pus cell on urinanalysisHypertension is common in chronic interstitial nephritis; Proteinuria is mild <1.5g/day.About other options:a. Post-infective glomerulonephritis: Absence of hematuria and presence of mild proteinuria rules out post infective glomerulonephritis. It is always accompanied by significant proteinuria and hematuriab. Accelerated hypertension with acute renal failure: This cannot explain the presence of pus cells on urinalysisc. Idiopathic RPGN: This also does not explain the presence of pus cells on urinalysis.
Post Infective glomerulonephritis
Accelerated hypertension with ARF
Idiopathic RPGN
Chronic interstitial nephritis with VUR
Kidney