A 15 year old presents with blood in urine after 2 days treatment for nephrotic syndrome. What is the diagnosis? How to manage the patient? ?

The diagnosis in this case would likely be acute glomerulonephritis, which can present with symptoms such as blood in the urine, proteinuria, and edema. This can occur as a complication of nephrotic syndrome or as a separate condition.

To manage the patient, the following steps can be taken:

1. Immediate referral to a nephrologist for further evaluation and management.
2. Further testing such as blood tests, urine tests, and imaging studies to confirm the diagnosis and assess the severity of the condition.
3. Treatment may include medications to reduce inflammation and control blood pressure, as well as dietary changes to reduce proteinuria.
4. Close monitoring of kidney function and symptoms to ensure proper management and prevent complications.
5. Education for the patient and family on the condition, treatment plan, and the importance of follow-up care.

Diagnosis:

Membranous glomerulonephritis (MGN)

Management:

1. Medical Treatment:

- Immunosuppressants: Prednisone or cyclophosphamide
- ACE inhibitors or ARBs: To reduce proteinuria and blood pressure

2. Monitoring:

- Monitor blood pressure, urine protein levels, and renal function regularly.

3. Diet:

- Low-protein diet to reduce proteinuria

4. Referral to a Nephrologist:

- For specialized care and long-term management of MGN

5. Additional Considerations:

- Avoid strenuous activity or contact sports until hematuria resolves.
- Consider a temporary course of heparin to prevent blood clots if hematuria is severe.
- In severe cases, dialysis or transplantation may be necessary.