Evaluating Face Swelling in a 5-Year Old Boy

In Episode 73 of Med School Question of the Week for USMLE, Hussain Rao, MedSchoolCoach expert tutor, answers this medical school question: A 5-year old boy is brought to the clinic by his parents due to concern about swelling of the patient’s face for the past few days. They note that the patient had a sore throat 3 weeks ago. They mention that the the swelling is primarily located around the patient’s eyes. They note that the boy has seasonal allergies and sometimes his eyes get puffy and resolve with anti-allergy medication. They state they are more concerned this time because there is more significant swelling than his previous allergic episodes. Physical examination confirms periorbital swelling and shows 2+ pitting edema of the lower extremities. Analysis of the patient’s urine reveals 4+ proteinuria and numerous fatty casts. UA is otherwise unremarkable. Which of the following is the best next step in management?

• Reassure the parents that this is likely allergies
• Anti-streptolysin O antibody level
• Administer furosemide
• Renal biopsy
• Prednisone therapy