M was brought to the clinic by his mother due to persistent fatigue, poor growth, and swelling in his legs over the past six months. He also complained of frequent headaches, difficulty concentrating in school, and reduced appetite. His mother reported that he has been falling behind in his physical development compared to other children his age. There is no recent history of fever, but his urine output has decreased, and it is often dark in color.

M had a history of recurrent throat infections during early childhood, which were untreated due to lack of access to healthcare. The family lives in a rural village with limited clean water access, and M has had several bouts of malaria in the past. No family history of kidney disease is reported.

Vital signs: Blood pressure: 140/90 mmHg (elevated for age), pulse 85 bpm, afebrile

General appearance: Appears pale and underweight, with stunted growth for his age

Cardiovascular and respiratory: No murmurs, clear lung fields

Abdomen: No tenderness, no hepatosplenomegaly

Extremities: Bilateral pitting oedema in lower limbs.

Neurological: No focal deficits, but mild difficulty concentrating

Laboratory Results:

Serum creatinine: Elevated (2.5 mg/dL)

Blood urea nitrogen (BUN): Elevated

Haemoglobin: Low (anaemia)

Electrolytes: Hypophosphatemia, hypocalcaemia

Urinalysis: Proteinuria, trace blood

Renal ultrasound: Bilateral small, echogenic kidneys suggestive of chronic kidney disease

Blood pressure monitoring: Hypertension confirmed

M is diagnosed with chronic kidney disease (CKD), likely secondary to chronic glomerulonephritis, possibly due to untreated streptococcal infections in childhood. His condition has progressed to stage 4 CKD, with evidence of hypertension, anaemia, and growth retardation.

1. Blood pressure control: Initiate antihypertensive therapy (ACE inhibitor) to manage hypertension and slow progression of kidney damage.
2. Nutritional support: High-calorie diet with restricted phosphorus intake and calcium supplementation to address malnutrition and electrolyte imbalances.
3. Anaemia management: Begin iron supplements and erythropoiesis-stimulating agents to treat anaemia.
4. Referral to a nephrologist: M will be referred to a regional hospital for specialized management, including long-term monitoring and potential dialysis planning as the disease progresses.
5. Education: Family counselling on M’s condition, importance of regular follow-up, and how to manage diet and fluid intake to preserve kidney function.

M’s prognosis will depend on the rate of progression of his CKD, adherence to treatment, and access to more advanced care such as dialysis.