Reference no: EM133758968

Question

A 7-year-old girl is brought to the emergency department by her parents for evaluation of a rash and diffuse intermittent abdominal pain. She has not experienced nausea, vomiting, or blood in the stool. The patient had an upper respiratory illness two weeks ago. The patient has no significant past medical history. Temperature is 37.2°C (99°F), blood pressure is 106/62 mmHg, heart rate is 99/min, respiratory rate is 26/min, and oxygen saturation is 99% on room air. Physical examination reveals a palpable purpuric rash on the legs bilaterally. Cardiopulmonary and abdominal examinations are within normal limits. There is swelling and pain with range of motion of the right knee. There is no lower extremity edema. Initial laboratory studies are shown below. Which of the following is the best next step in management? Laboratory value Result Hemoglobin 12 g/dL Hematocrit 40% Leukocyte count 10,000 /mm3 Platelet count 400,000/mm3 Creatinine 0.6 mg/dL PTT 27 s PT 13 s Elimination tool Urinalysis Renal ultrasound No further testing is necessary Skin biopsy Renal biopsy.