A 10-year-old boy named Md. Miraz was admitted with facial swelling, scanty micturition, and generalized weakness, which began following a throat infection. Examination revealed mild anemia and a blood pressure of 140/90 mmHg, with the provisional diagnosis of acute glomerulonephritis supported by laboratory findings and a positive ASO titer. Treatment involves bed rest, fluid and salt restriction, diuretics, and antibiotics.

1. A 10 years old boy presented
with swelling and puffiness of
the face &
scanty micturition.
Presented by-
DR. MUNTASIR MAMUN
Indoor Medical Officer
Dept. of NEPHROLOGY
TMC & RCH
Bogura

2. Particulars of the patient:
• Name : Md. Miraz
• Age: 10 y
• Sex: Male
• Religion: Islam
• Marital status : Unmarried
• Occupation : student
• Address: Gobindagonj, Gaibandha.
• Date and time of admission: 01.01.25@ 04.30 pm.
• Date and time of examination: 04.01.25@10.35 am.

3. Presenting complaints:
• Swelling and puffiness of the face for 03 days.
• Scanty micturition for 03 days
• Generalized weakness, loss of appetite for 07
days.

4. History of presenting illness:
According to the patient’s statement, he was
suffering from pain in the throat with dry cough 3
weeks back from which there was complete
recovery.
For the last 03 days, she has noticed swelling and
puffiness of the face, which is more marked in the
morning after waking from sleep.
He also complains of scanty micturition for 03
days, which is slightly smoky and high colored,
but no frank blood. The patient also complains of
weakness and loss of appetite for 10 days.

5. Cont..
There is no history of difficulty in breathing,
convulsion or unconsciousness or loin pain.
he does not give any history of skin infection, arthritis
or arthralgia.
The patient has no recent or past history of yellow coloration
of sclera or any other parts of
the body.
With these above complaints he admitted in Nephrology male ward
of RCH for better management.

6. History of past illness:
The patient has no HTN and diabetic. Patient
had no previous history of generlalized body
swelling

7. Drug history:
Patient took paracetamol for pain and sore throat
but there is no history of taking anti
hypertensive drug.

8. PERSONAL HISTORY:
Nothing significant

9. FAMILY HISTORY:
None his family member is suffering from this
type of disease.
They are healthy and enjoining sound health.

10. Socio-economic history:
He belongs to a middle class family and He lives in a
semi-pakka house & uses sanitary latrine.

11. Immunization History:
He is immunized according to EPI schedule & also
immunized against covid-19.

12. GENERAL EXAMINATION:
Appearance – puffy face
Body built – average
Nutritional status –average
Decubitus: on choice
Co-operation : Well co-operative
Anaemia : mild
Jaundice : Absent
Cyanosis : Absent
Clubbing : Absent
Koilonychia : Absent
Leuconychia : Absent
Oedema : Abcent
Dehydration – Nill
Skin – No scratch mark present over hand and abdomen and no scar of
healed skin infection

13. Cont…
Body hair distribution – normal distribution hair.
Bony tenderness – absent
Lymph node – no lymphadenopathy
Thyroid gland – not palpable
Neck vein – not engorged
Pulse – 78/min, normal volume, regular.
B.P – 140/90 mm of Hg
Respiratory rate – 25/min
Temperature – 98 F
Weight : 28 kg
Height : 121 cm

14. Systemic Examination:
Gastrointestinal System:
Mouth, lip, oral cavity—all normal.
Abdomen:
Inspection: No abnormality detected.
Palpation:
No organomegaly , Kidneys are not ballotable
Fluid thrill—absent
There is no tenderness over the renal angle.
3. Percussion: Shifting dullness absent.
4. Auscultation: No renal bruit

15. CARDIVASCULAR SYSTEM:
•Pulse : 78 b/min
Regular, normal in volume & character, all the
peripheral pulses are normal.
•BP : 140/90 mm of Hg
•JVP : Not raised
•Precordium :
Inspection: Normal
Palpation: Apex beat in lt 5th intercostals space 9 cm
from midline No para-sternal heave and no palpable
Auscultation: S1&S2 audible in all auscultatory area
No added sound and no murmur

16. Other systemic examination
reveals no abnormality.

17. Salient feature:
Md. Miraz 10 years old, student, normotensive, nondiabetic,
hailing from gobindogonj, gaibandha was suffering from pain
in the throat with dry cough 3 weeks back from which there
was complete recovery. For the last 03 days, he has noticed
swelling and puffiness of the face, which is more marked in the
morning after waking from sleep. he also complains of scanty
micturition, which is slightly smoky and high
colored, but no frank blood. The patient also complains of
weakness and loss of appetite for 07 days. There is no history
of difficulty in breathing, convulsion or unconsciousness or
loin pain.
She does not give history of any skin infection, arthritis or
arthralgia.

18. Cont…
There were no previous history of jaundice and no history of
similar type of attack . On General examination reveals patient is
ill looking with puffy face, mildly anaemic and, non ecteric and
with blood pressure 140/ 90 mmhg , JVP not raised The patient has
no feature of mal-absorption and hepatic insufficiency but there is
no scratch mark present over hand and abdomen and IV canula in
situ.
Other systemic examination reveals no abnormality.

19. Provisional Diagnosis:

20. Provisional diagnosis:
Acute glomerulonephritis

21. Differential diagnosis:
Nephrotic syndrome.

22. Investigations &

23. kj
•CBC:
Hb:8.50 g/dl
ESR:700 mm
WBC(TC):4.40K/ul
Platelet:274 k/ul

24. Urine R/M/E:
Appearance: hazy
Pus cell :150-200/HPF
Epithelial cell:5-10/HPF
Albumin: present(++)
RBC: 10-15

25. Urine for C/S:
Enterococcus sp.
Sensative:
amicacin,
vancomycin,
gentamycin.

26. ASO Titre:
400IU
(positive)

27. Urine ACR:
648.10mg/g

28. S. electrolyte:
na+ 142
k+ 3.63
cl- 103
Eco2 19
S.creatinine:
1.14
S.Urea:
78

29. HBsAg
&
Anti-HCV
(Negative)

30. USG of
W/A:
Bilateral pleural.
Effusion
Minimal Ascites

31. Serum C3
0.12
Compliment C4
0.34

32. Iron profile:
S. Iron 77
S. TIBC 180
S. Ferritin 925
Transferin
saturation 42.77%

33. S. procalcitonin:
0.22

34. Plan:
ANA, Anti-dsDNA,
P-ANCA, C-ANCA
Renal biopsy

35. Confirmatory Diagnosis:
Acute glomerulonephritis (most
likely post-streptococcal)

36. Treatment:
Bed Rest
Fluid restriction (total intake 500 to 1000 mL/day)
Salt restriction
Protein restriction
Diuretics (frusaemide in tab form)
Antibiotic— inj. Amikacin 500mg
Corticosteroid- tab. Prednisolone 30mg daily at
morning