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APSGN from skin sores — RACP Paediatrics MCQ

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HardIDAPSGN from skin soresRACP Paediatrics

An 8-year-old Aboriginal child has oedema and macroscopic haematuria two weeks after impetigo. Blood pressure is above the 99th centile plus 35 mmHg, oxygen saturation is 89%, chest radiography shows pulmonary oedema and urine output is falling. Which immediate plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Restrict dietary salt and fluid, administer furosemide and escalate care

Explanation lettering: B = shown as A · D = shown as B · E = shown as D · A = shown as E

A is correct. This is PSGN with severe hypertension, pulmonary oedema and oliguria: salt/fluid restriction, loop diuresis and urgent nephrology/intensive-care escalation address the immediate threats. B worsens fluid overload. C corticosteroid is not routine treatment for uncomplicated PSGN. D renin–angiotensin blockade alone is too slow and may worsen acute kidney injury. E antibiotics may eradicate residual GAS carriage but cannot manage the cardiorespiratory emergency.

Reference: RCH Melbourne, Post-streptococcal glomerulonephritis: https://www.rch.org.au/clinicalguide/guideline_index/Post-streptococcal_glomerulonephritis_%28PSGN%29/