An 11 year old boy living in an isolated village was experiencing drastic weight

Question

An 11 year old boy living in an isolated village was experiencing drastic weight gain, with abdominal distension, in a period of 16 days. He complained of feeling weak, lethargic, and his "belly" was bothering him. His mother noticed traces of blood in his urine. The child was taken to the nearest hospital. His past medical history was significant for a recent episode of a cold nad sore throat that were self-limiting conditions. Physical exam revealed generalized edema (anasarca), along with swelling of the abdomen and genitalia. There was tenderness on palpation to the abdomen and genital areas. Basic blood chemistry was within normal limits. A serum antistreptolysin O antibody was positive with a significant degree of hypoalbuminemia. Urinalysis demonstrated proteinuria (2.5 gr/day) and traces of blood (hematuria), as well some hemoglobin casts in the urine (hemoglobinuria). This patient was hospitalized and placed on a tapering prednisone therapy.

1. What is the significance of the antistreptolysin O antibody finding?
2. Why was prednisone initiated?
3. Should this patient be placed on a special diet?
4. What is or should be the goal of this treatment regimes?
5. What could have caused the abnormal proteinuria and edema?
6. What organ(s) could have been affected by this condition?
7. Should any other tests have been done?

Explanation / Answer

Great medicine question! I'll do my best on this one but it's worth fact-checking. I'd suggest basic resources on glomerulonephritis, strep, or else a basic pathology textbook.

1. What is the significance of the antistreptolysin O antibody finding?
Based on the history and findings, the patient most likely has post-streptococcal glomerulonephritis (ie damage to the glomerulus/filter in the kidney following strep infection). A positive antistreptolysin O Ab (aka "ASO") test + the history of recent infection is a red flag for this. Other symptoms consistent with kidney disease include protein in the urine (proteinuria), blood in urine (hematuria) which are usually never present, and the swelling/tenderness from edema are a result of the protein loss. Heart sounds would also be abnormal and a biopsy would show the PS-GN.

2. Why was prednisone initiated?
Prednisone is a corticosteroid (like cortisol) which reduces inflammation. It's intended to lessen the severity of the inflammatory response which is causing the severe symptoms, pain, etc. However, I've read a few sources indicating that prednisone isn't ultimately very useful in this case. BUT, don't take my word for it on this one. Another treatment might be continued antibiotics to make sure any lingering bacteria is gone.

3. Should this patient be placed on a special diet?
Yes, a low salt diet is key.

4. What is or should be the goal of this treatment regimes?
In most cases the glomerulonephritis (GN) will resolve on its own after several months. In the mean time, it's most important to (1) treat the symptoms so it doesn't worsen/progress (2) follow up and watch out for progression to kidney failure.

5. What could have caused the abnormal proteinuria and edema?
The glomerulus (molecular filter) in his kidney has been damaged due to strep infection. As a result, protein which is normally too large to leave plasma is able to leave, ending up in kidney tubules where it is then excreted into urine. As a result of low plasma osmolarity, fluid that leaves capillaries due to high blood pressure has no opposing force to bring fluid back into the capillaries. Normally the high plasma osmolarity due to proteins such as albumin would do this. So the fluid just stays in the interstitial space (aka edema). It's most easily seen in the abdomen here.

6. What organ(s) could have been affected by this condition?
Um, kidney. The heart, face, eyes, feet, abdomen are also affected. Lungs may be affected if pulmonary edema occurs.

7. Should any other tests have been done?
Titers to determine the presence of infection would be useful. A biopsy of the kidney would confirm GN, but it's painful and the ASO test already gives you what you need.

Related Questions

Navigate

• Browse (All)
• Browse A
• Subjects

---

---

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.