A 13-year-old child with ...

A 13-year-old male child presented with anuria for 3 days, lethargy, and fatigue, and was admitted to the Pediatric Intensive Care Unit (PICU). Catheterization was done, but no urine was obtained. Fluid bolus challenge was performed, but still no urine was produced. Blood investigations revealed elevated creatinine levels (5.4), urea (200), and bulky kidneys with bladder diverticula on ultrasound. Hemodialysis was initiated and continued for 3 days, resulting in a decrease in creatinine (3.5) and urea (160), but anuria persisted. CT abdomen and KUB ruled out postrenal obstruction as a cause of acute kidney injury (AKI), and CKD presenting with AKI was considered less likely. However, further investigations, including renal biopsy and pending results of ASO, ANA, and complement levels, are planned. The patient's past medical history includes a previous diagnosis of acute disseminated encephalomyelitis (ADEM) at the age of 2, treated at that time but lost to follow-up with the neurophysician due to vision loss. The patient also had left hip subluxation surgery 4-5 years ago and is known to have moderate mental retardation. Suggestions are invited for the next steps in managing this complex case.