Case of Child with Edema and Decreased Urine Output

History:

A 10 years old child presented to the hospital complaining of swelling of his ankles, abdomen and eyelids for the past 4 days. He also thought that he had gained weight recently. In the morning his legs were less swollen, but his eyes appeared ‘puffy’. He thought that he might be urinating less frequently.

Examination:

On examination blood pressure was 110/68 mm Hg. There was mild edema of the eyelids. There was pitting edema on the ankles. A chest film was obtained and showed bilateral pleural effusions.

Laboratory Investigations:

Urine routine examination report revealed:

Urinalysis	Results	Reference Range
pH	6	4.6 – 8.0
Specific Gravity	1.050	1.001 – 1.036
Protein	+++	Negative
Glucose	Negative	Negative
Serum Urea	6.9	3.9 – 6.7 mmol/L
Serum Creatinine	88	53 – 106 mmol/L

Tasks:

1. Explain the sign and symptoms in this patient.
2. Describe the biochemical basis of disease.
3. What other laboratory tests should be done?
4. What is the diagnosis?