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A 7-year-old boy is brought to the emergency department by his mother because of "tea-colored urine" for the last several days. He has also had some nausea and vomiting, and his eyes appear swollen when he wakes up in the morning. The eye swelling tends to resolve over the course of the day. He is generally very healthy and there is no family history of any chronic diseases. His temperature is 36.7 C (98.0 F), blood pressure is 130/90 mm Hg, pulse is 96/min, and respiratory rate is 16/min. Physical examination is unremarkable. A urinalysis shows red cell casts. At this time the most appropriate study to confirm your diagnosis is
A. antinuclear antibody
B. antistreptolysin O antibody
C. renal biopsy
D. renal ultrasound
E. urine culture 

C.

bb i don't think bpx is done in kids initially

it says to CONFIRM your dx

you don't do it for confirmation , use 2- trial of steroid if protein urea doesn't stop than bpx

but the vignett is nephritic not nephrotic

you are very right ,and that is the reason why we do ASO to see if GN, but I think you still don't do bpx, so just penicillin, let's wait for some more inputs

B.

the dx is nephritic syndrome so the most appropriate test to confirm is renal biospy , i would go with c , please clarify me .

no B