A five-year-old boy presented with five days of dark-colored urine, swelling around his eyelids, and a recent rash over his left lower leg that itself had started over three weeks ago. He lived relatively closer than many patients, a one and a half hour walk from Bayalpata. He was brought in by his father. The swelling around his eyes had improved considerably over the two days prior to him coming to the hospital. He had no blood in his stool. Our Health Assistant, Udayji, evaluated the child, who was found to have red blood cells in his urine, high blood pressure for his age (128/84), and a rash over his left leg. His abdomen was soft. Udayji called Dr. Sizan Thapa, our Medical Director, to assist with the case. Fortunately, his renal function, measured by our i-Stat device, was normal. While there were other potential causes of the inflammatory changes likely taking place in his kidneys (such as various autoimmune diseases), our team felt that this was most likely post-streptococcal (from the rash) glomerulonephritis. The team prescribed antibiotics for the skin lesions; no other treatments were indicated. His blood pressure was not so high that it warranted anti-hypertensive treatment, and, since he lived relatively close, he could return later in the week for us to reassess his blood pressure and kidney function. While we didn’t have additional specialized tests, this was one child for whom I felt we had fairly adequate diagnostics and treatments at our disposal. Unfortunately, we do not yet have a Community Health Worker (CHW) program in his village to ensure that he follows up, though we hope to be expanding our CHW network there soon.
Rash over patient’s lower left leg.
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Duncan Maru, MD, PhD is a co-founder of Nyaya Health. He is currently a resident in the Internal Medicine – Pediatrics program and fellow in Global Health Equity at Brigham and Women’s Hospital and Children’s Hospital of Boston.
