F’s parents brought her to the local clinic after noticing that her face, particularly around her eyes, had become swollen over the past three days. The swelling was worse in the mornings and improved slightly during the day. They also reported that her urine appeared dark, like “tea,” and that her urine output had decreased significantly. F has been complaining of mild headaches and some discomfort in her abdomen but has no fever. The family mentions that she had a sore throat two weeks ago, which was treated with traditional remedies, but she did not visit a healthcare facility.

F has no known history of kidney disease or other chronic illnesses. She has had occasional sore throats but otherwise enjoys good health. The family relies on untreated river water for drinking and household purposes.

Vital signs: Blood pressure: 130/85 mmHg (elevated for her age), pulse 90 bpm, afebrile

General appearance: Appears well-nourished but with noticeable puffiness around her eyes and mild swelling in her lower legs

Cardiovascular and respiratory: Normal heart sounds, clear lung fields

Abdomen: Mild tenderness, no palpable masses

Extremities: Bilateral pitting oedema of the lower limbs

Urine output: Decreased, dark-coloured urine

Laboratory Results:

Urinalysis: Haematuria (gross blood), proteinuria (+), no significant white blood cells

Serum creatinine: Mildly elevated

Electrolytes: Mild hyperkalaemia

ASO titer: Elevated, suggestive of recent streptococcal infection

Renal ultrasound: Normal kidney size and shape, no evidence of chronic disease

F is diagnosed with acute post-streptococcal glomerulonephritis (APSGN), likely triggered by a recent streptococcal throat infection. The presence of hematuria, proteinuria, and recent sore throat, along with elevated ASO titer, support the diagnosis.

1. Blood pressure control: Begin antihypertensive therapy (nifedipine) to manage her elevated blood pressure.
2. Fluid management: Limit fluid and salt intake to reduce edema and hypertension.
3. Monitor kidney function: Serial measurements of serum creatinine, electrolytes, and urine output.
4. Treat the underlying infection: While the acute infection is likely resolved, antibiotic therapy (penicillin) may be considered to prevent future streptococcal infections.
5. Follow-up: Monitor F for resolution of symptoms and improvement in kidney function over the next few weeks, as APSGN is usually self-limiting with appropriate supportive care.

F's prognosis is generally good, with most cases of acute post-streptococcal glomerulonephritis resolving spontaneously, though close monitoring is needed to ensure no progression to chronic kidney disease.