The nurse is reviewing the Laboratory Results from week 1 at 1100. For each finding, click to specify if the finding is consistent with acute post streptococcal glomerulonephritis (APSGN) or minimal change nephrotic syndrome (MCNS). Each finding may support more than 1 disease process or none at all. There must be at least 1 selection in every column. Ther e does not need to be a selection in every row.

Distinguishing between Acute poststreptococcal glomerulonephritis (APSGN) and minimal change nephrotic syndrome (MCNS) is vital in pediatric nursing, as both present with edema but have different underlying mechanisms. APSGN is an immune-complex disease following a streptococcal infection, leading to glomerular inflammation and decreased filtration. MCNS involves increased glomerular permeability, specifically to proteins, resulting in massive proteinuria and significant fluid shifts. While both conditions involve the kidneys, the presence of hypertension and the degree of lipid elevation often serve as key clinical differentiators. Rationale: • Facial appearance: Facial puffiness, especially periorbital edema, is common in both APSGN and MCNS due to fluid retention and altered fluid balance. In APSGN, edema occurs because of reduced glomerular filtration and sodium retention. In MCNS, edema results from severe protein loss causing reduced plasma oncotic pressure and movement of fluid into tissues. Because both conditions commonly present with periorbital swelling, this finding supports both • Blood pressure: Elevated blood pressure is more characteristic of APSGN because inflammation of the glomeruli decreases filtration and causes sodium and water retention. This increases circulating volume and leads to hypertension. In this child, a blood pressure of 110/82 mm Hg is elevated for a 7-year-old and supports nephritic syndrome. MCNS usually presents with normal or low-normal blood pressure unless severe complications develop. • Urine protein: Massive proteinuria, shown by +++ protein in the urine and frothy urine, is a hallmark of nephrotic syndrome, especially MCNS. Damage to the glomerular membrane allows large amounts of protein, mainly albumin, to leak into the urine. This causes hypoalbuminemia and generalized edema. APSGN may have mild proteinuria, but heavy protein loss is much more consistent with MCNS. • Low-density lipoproteins: Elevated LDL levels are strongly associated with nephrotic syndrome because the liver increases lipoprotein production in response to low serum albumin. Hyperlipidemia is a classic feature of MCNS and helps distinguish it from APSGN. This child’s LDL of 120 mg/dL supports nephrotic syndrome rather than nephritic syndrome. APSGN does not typically cause significant hyperlipidemia.