Oedema in children: diagnostic approach — formative SAQs

SAQ 1 (10)

A 4-year-old develops progressive periorbital and leg pitting oedema over 1 week. He is afebrile and interactive. BP is 96/60. Urine dipstick shows 4+ protein and no blood. [1] [3]

1. Write a one-sentence problem representation and name the most likely mechanism bucket. (3) [1] [2]
2. List the immediate bedside assessments that branch management in the first minutes. (3) [1]
3. Outline your investigation and initial management plan, including safety-net and why blind diuresis is risky. (4) [1] [2] [3]

Model answer

Problem representation / mechanism. Acute generalised pitting oedema in a preschool child with heavy proteinuria and normal BP — nephrotic pattern; low oncotic pressure from urinary protein loss is the leading mechanism. [1] [2] [3]

Bedside branches. Threat (ABC), confirm true oedema and distribution, weight, blood pressure, urine dipstick, perfusion/intravascular status, look for infection. [1]

Plan. Confirm albumin and renal function; quantify proteinuria as available; admit/same-day nephrotic pathway per local practice; salt/fluid strategy; infection precautions; IPNA/KDIGO-aligned steroid framework with specialist input; teach fever/abdominal pain/breathing red flags. Blind diuresis risks shock if intravascular underfill coexists with tissue oedema. [1] [2] [3]

SAQ 2 (10)

A 8-year-old in a high streptococcal burden community presents with facial swelling, dark urine and headache after recent impetigo. BP is 148/96. [4] [5]

1. Contrast this nephritic pattern with idiopathic nephrotic oedema using three discriminators. (3) [1] [4]
2. State two immediate threats you must address. (2) [4] [5]
3. Outline first-line supportive management principles and follow-up priorities (without inventing uncited drug doses). (5) [4] [5]

Model answer

Discriminators. Nephritic: haematuria, hypertension, often oliguria/renal impairment; oedema may be milder. Nephrotic: heavy protein, hypoalbuminaemia, often normal BP at onset, more anasarca. Post-infectious timing supports APSGN. [1] [4]

Threats. Hypertensive emergency/encephalopathy risk; fluid overload/pulmonary oedema; acute kidney injury. [4] [5]

Plan. ABC and controlled BP management via local hypertensive emergency pathways; fluid and sodium restriction as indicated; labs (creatinine, electrolytes, complement/streptococcal tests as appropriate); nephrology involvement; public-health awareness in high-burden settings; planned follow-up of BP and renal function. Do not invent antihypertensives mg/kg from memory if not cited — name local protocol. [4] [5]