A 3-year-old patient is admitted to the Emergency Room

Vital signs

• Temperature-102.3
• Weight 16 kg
• Respiratory rate-44
• Blood pressure- 98/62
• Heart rate-122

History of present illness

Mom brought the child to the ER presenting with a fever for 6 days a strawberry tongue, cervical lymphadenopathy, and irritable

Complete the following sentence from the list of options

The patient is at the highest risk for developing.......

evidenced by the patient's diagnosis of …....

A. Weighing the child daily (A) is the most accurate and objective method for monitoring fluid retention in a child with nephrotic syndrome. Nephrotic syndrome can lead to significant fluid retention due to proteinuria and hypoalbuminemia. Daily weight measurements can detect even small changes in body weight, which may be indicative of fluid accumulation. It is a sensitive and specific measure for assessing fluid status.
B. Measuring the abdominal girth weekly (B) can provide some information about abdominal distension, but it is not as precise or sensitive as daily weight measurements. Weight gain or loss can occur without significant changes in abdominal girth, especially in children.
C. Counting the number of wet diapers (C) may provide some information about urinary output, but it does not directly measure overall fluid retention or body weight changes. It is not as reliable as daily weight measurements for assessing fluid status.
D. Testing the urine for hematuria (D) is a valuable diagnostic test to assess kidney function and the presence of blood in the urine, but it does not directly measure fluid retention. Hematuria is not typically the primary indicator of fluid overload in nephrotic syndrome.
In summary, daily weight measurements are the best way to monitor fluid retention in a child with nephrotic syndrome, as they provide a direct and objective assessment of changes in fluid status. This allows healthcare providers to make timely adjustments to the child's treatment plan if necessary.

APSGN is characterized by inflammation of the glomeruli in the kidneys, which can lead to decreased kidney function and impaired urine output. As the condition begins to improve, one of the first signs is an increase in urine output. This is because the inflammation in the glomeruli starts to resolve, allowing the kidneys to filter blood more effectively and produce a higher volume of urine.

Now, let's discuss why the other options are incorrect:

A. Increased energy levels: While improved energy levels can be a positive sign in a child recovering from an illness, they are not typically the earliest sign of improvement in APSGN. Energy levels may improve as the child's overall condition gets better, but this improvement often follows an increase in urine output.

B. Decreased diarrhea: APSGN primarily affects the kidneys, not the gastrointestinal tract. Therefore, diarrhea is not a direct symptom of this condition. Improving kidney function and urine output would not directly impact diarrhea.

D. Increased appetite: Like increased energy levels, an improved appetite can be a positive sign in recovery, but it is not typically the earliest sign of improvement in APSGN. It is generally more related to overall recovery and feeling better after the acute phase of the illness.

In summary, while all of these signs can be positive indicators of a child's recovery, increased urine output is usually the earliest and most specific sign of improvement in acute post-streptococcal glomerulonephritis, as it directly reflects the resolution of kidney dysfunction.