A 6-year-old child presents with tea-colored (smoky) urine, periorbital edema upon waking, and blood pressure of 130/85 mmHg. Two weeks ago, he was treated for impetigo skin lesions. Urinalysis demonstrates dysmorphic RBCs, RBC casts, and moderate proteinuria. What is the diagnosis?

Answer and explanation

Correct answer: C. Post-streptococcal glomerulonephritis (PSGN)

  1. Step 1: The acute nephritic syndrome (hematuria with RBC casts, hypertension, periorbital edema) occurring 1 to 3 weeks after streptococcal pharyngitis or 3 to 6 weeks after impetigo is characteristic of PSGN.
  2. Step 2: Immune complex deposition is confirmed by low serum complement C3 and elevated anti-streptolysin O (ASO) or anti-DNase B titers.
Answer
Post-streptococcal glomerulonephritis (PSGN).
Why not the others: 'Minimal change disease (nephrotic syndrome)' presents with massive proteinuria (> 3.5 g/day), hypoalbuminemia, and generalized anasarca without RBC casts; 'IgA nephropathy (Berger disease)' presents with gross hematuria concurrently with an upper respiratory infection (synpharyngitic); 'Hemolytic uremic syndrome (HUS)' presents with microangiopathic hemolytic anemia, thrombocytopenia, and renal failure following bloody diarrhea.

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