Parents have adopted a child with the diagnosis of kwashiorkor. What is most likely to be observed when assessing this child? (Select all that apply)

Choice A reason: No activity restrictions are inappropriate in acute glomerulonephritis with edema, as exertion may worsen hypertension or renal strain. Gross hematuria indicates active glomerular inflammation, requiring limited activity to reduce cardiovascular stress and promote renal healing, making unrestricted activity an incorrect instruction for managing this condition.

Choice B reason: Limiting activity until gross hematuria subsides in acute glomerulonephritis reduces renal and cardiovascular stress, preventing exacerbation of hypertension or hematuria. Rest promotes glomerular healing by minimizing blood pressure spikes. This is the priority instruction, as hematuria signals active disease, requiring cautious management to prevent complications.

Choice C reason: A high-potassium diet (e.g., bananas) is contraindicated in acute glomerulonephritis, as impaired renal function may cause hyperkalemia, risking arrhythmias. Low-potassium diets are often recommended. Limiting activity addresses hematuria and hypertension, making high-potassium intake an incorrect and potentially harmful instruction for this condition.

Choice D reason: Bedrest for 2 weeks is excessive in acute glomerulonephritis, as most children recover with limited activity until hematuria resolves. Prolonged bedrest risks complications like thrombosis without evidence of benefit. Limiting activity based on hematuria is more targeted, making fixed bedrest an incorrect and overly restrictive instruction.

Choice A reason: Ewing sarcoma is a bone or soft tissue malignancy, not primarily a renal or intra-abdominal tumor. It affects bones or soft tissues, causing pain or swelling, not abdominal masses. Wilms’ tumor is the most common renal malignancy in children, making Ewing sarcoma an incorrect choice for this context.

Choice B reason: Osteosarcoma is a bone cancer, typically affecting long bones, not the kidneys or intra-abdominal organs. It presents with bone pain or fractures, not abdominal masses. Wilms’ tumor, a renal malignancy, is the most common in this category, making osteosarcoma irrelevant to renal or intra-abdominal cancers.

Choice C reason: Neuroblastoma, an intra-abdominal malignancy, arises from neural crest cells, often in the adrenal glands, causing abdominal masses. While common, it is less frequent than Wilms’ tumor in the renal/intra-abdominal category. Wilms’ tumor’s higher incidence in children makes neuroblastoma a less accurate choice for the most common tumor.

Choice D reason: Wilms’ tumor is the most common malignant renal and intra-abdominal tumor in children, originating in the kidney and presenting as a painless abdominal mass. Its embryonal origin and high incidence in young children make it the primary focus in teaching about pediatric renal malignancies, distinguishing it from other cancers.