const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Approach to Hematuria in Pediatrics";
pres.author = "Orris Medical Education";

// ── Color palette ──────────────────────────────────────────────────────────
const C = {
  navy:    "0D2B55",   // dominant dark
  teal:    "1A7A8A",   // section accent
  gold:    "E8A020",   // highlight accent
  cream:   "F5F0E8",   // light background
  white:   "FFFFFF",
  red:     "C0392B",   // gross hematuria
  blue:    "2471A3",   // microscopic hematuria
  lightTeal: "D4EEF1",
  lightGold: "FCF0D5",
  midGray: "5D6D7E",
  lightGray: "ECF0F1",
};

// ── Helper: section banner ─────────────────────────────────────────────────
function addSectionBanner(slide, label) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.35, fill: { color: C.gold }, line: { color: C.gold } });
  slide.addText(label, { x: 0, y: 0, w: 10, h: 0.35, fontSize: 9, bold: true, color: C.navy, align: "center", valign: "middle", margin: 0 });
}

// ── Helper: slide title bar ────────────────────────────────────────────────
function addTitleBar(slide, title, sub) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.35, w: 10, h: 0.92, fill: { color: C.navy }, line: { color: C.navy } });
  slide.addText(title, { x: 0.3, y: 0.35, w: 9.4, h: 0.6, fontSize: 22, bold: true, color: C.white, valign: "bottom", margin: 0 });
  if (sub) {
    slide.addText(sub, { x: 0.3, y: 0.95, w: 9.4, h: 0.32, fontSize: 12, color: C.gold, valign: "top", margin: 0 });
  }
}

// ── Helper: footer ─────────────────────────────────────────────────────────
function addFooter(slide, note) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.35, w: 10, h: 0.275, fill: { color: C.navy }, line: { color: C.navy } });
  slide.addText(note || "Campbell-Walsh-Wein Urology | Pediatric Nephrology Reference", {
    x: 0.3, y: 5.35, w: 9.4, h: 0.275, fontSize: 8, color: C.gold, valign: "middle", margin: 0
  });
}

// ── Helper: colored box ────────────────────────────────────────────────────
function addBox(slide, x, y, w, h, fill, line) {
  slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: fill }, line: { color: line || fill } });
}

// ── Helper: bullet block ───────────────────────────────────────────────────
function bulletsText(items, opts = {}) {
  return items.map((t, i) => ({
    text: t,
    options: { bullet: { code: "2022", indent: 10 }, breakLine: i < items.length - 1, ...opts }
  }));
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — Title
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  // Full dark background
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy }, line: { color: C.navy } });

  // Decorative teal side panel
  s.addShape(pres.ShapeType.rect, { x: 7.6, y: 0, w: 2.4, h: 5.625, fill: { color: C.teal }, line: { color: C.teal } });

  // Gold accent bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 1.5, w: 7.6, h: 0.08, fill: { color: C.gold }, line: { color: C.gold } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.0, w: 7.6, h: 0.08, fill: { color: C.gold }, line: { color: C.gold } });

  s.addText("APPROACH TO", { x: 0.5, y: 0.6, w: 7, h: 0.55, fontSize: 18, bold: false, color: C.gold, charSpacing: 6 });
  s.addText("HEMATURIA", { x: 0.5, y: 1.1, w: 7, h: 1.1, fontSize: 52, bold: true, color: C.white, charSpacing: 2 });
  s.addText("IN PEDIATRICS", { x: 0.5, y: 2.15, w: 7, h: 0.7, fontSize: 26, bold: false, color: C.lightTeal, charSpacing: 4 });

  s.addText([
    { text: "Definition  •  Epidemiology  •  Classification", options: { breakLine: true } },
    { text: "Causes  •  Evaluation  •  Management", options: {} }
  ], { x: 0.5, y: 3.0, w: 7, h: 0.8, fontSize: 13, color: C.lightGray, italic: true });

  // Right panel content
  s.addText("KEY TOPICS", { x: 7.7, y: 0.4, w: 2.2, h: 0.4, fontSize: 10, bold: true, color: C.white, align: "center", charSpacing: 3 });
  const topics = ["Definition", "Epidemiology", "Causes", "History & Exam", "Investigations", "Gross vs Micro", "Glomerular vs Non-", "Management", "Red Flags", "Referral"];
  topics.forEach((t, i) => {
    s.addText(`${i + 1}. ${t}`, { x: 7.65, y: 0.9 + i * 0.42, w: 2.3, h: 0.38, fontSize: 9.5, color: C.white, align: "left" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — Definition & Epidemiology
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "DEFINITION & EPIDEMIOLOGY");
  addTitleBar(s, "What is Hematuria?", "Definitions and key epidemiological facts");

  // Two cards
  // Left card - gross
  addBox(s, 0.3, 1.45, 4.5, 1.4, C.red, C.red);
  s.addText("GROSS HEMATURIA", { x: 0.3, y: 1.45, w: 4.5, h: 0.4, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
  addBox(s, 0.3, 1.85, 4.5, 1.0, "FDDBD8", "FDDBD8");
  s.addText([
    { text: "• Visible red or tea-colored urine", options: { breakLine: true } },
    { text: "• Confirmed by dipstick + microscopy", options: { breakLine: true } },
    { text: "• ~0.13% of pediatric ED visits", options: {} }
  ], { x: 0.4, y: 1.88, w: 4.3, h: 0.95, fontSize: 11, color: C.navy });

  // Right card - microscopic
  addBox(s, 5.2, 1.45, 4.5, 1.4, C.blue, C.blue);
  s.addText("MICROSCOPIC HEMATURIA", { x: 5.2, y: 1.45, w: 4.5, h: 0.4, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
  addBox(s, 5.2, 1.85, 4.5, 1.0, "D4E8F7", "D4E8F7");
  s.addText([
    { text: "• Yellow urine, dipstick positive for blood", options: { breakLine: true } },
    { text: "• >5 RBCs/hpf on freshly spun sample", options: { breakLine: true } },
    { text: "• ~1% of school-age children", options: {} }
  ], { x: 5.3, y: 1.88, w: 4.3, h: 0.95, fontSize: 11, color: C.navy });

  // Epidemiology key points
  addBox(s, 0.3, 3.0, 9.4, 1.5, C.lightTeal, C.teal);
  s.addText("EPIDEMIOLOGY AT A GLANCE", { x: 0.3, y: 3.0, w: 9.4, h: 0.35, fontSize: 11, bold: true, color: C.teal, align: "center", valign: "middle", margin: 4 });
  s.addText([
    { text: "Microscopic hematuria: ~1% prevalence in school-age children (Dodge et al., 1976; Vehaskari et al., 1979)", options: { breakLine: true } },
    { text: "<25% persist on repeat testing; most resolve spontaneously within 1 year  •  Definitive diagnosis established in <30% of cases", options: { breakLine: true } },
    { text: "Gross hematuria: easier to diagnose — underlying cause identified in majority of cases", options: {} }
  ], { x: 0.5, y: 3.35, w: 9.0, h: 1.1, fontSize: 10.5, color: C.navy });

  addFooter(s, "Campbell-Walsh-Wein Urology, Pediatric Nephrology Chapter | BOX 21.1");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — Causes of Hematuria (Gross)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "ETIOLOGY");
  addTitleBar(s, "Causes of Gross Hematuria in Children", "BOX 21.1 – Campbell-Walsh-Wein Urology");

  const grossCauses = [
    ["UTI / Cystitis", "Most common cause — 26% of cases"],
    ["Perineal Irritation", "11% of cases"],
    ["Trauma", "7% — CT abdomen often needed"],
    ["Meatal Stenosis / Ulceration", "7% in boys"],
    ["Coagulation Abnormalities", "Bleeding diathesis — 3%"],
    ["Nephrolithiasis / Hypercalciuria", "Flank pain, family history of stones"],
    ["Glomerulonephritis", "Tea-colored urine, HTN, edema, proteinuria"],
    ["Wilms Tumor / Bladder Tumor", "Abdominal mass in young children"],
    ["Renal Vein Thrombosis", "Neonates, hypercoagulable states"],
    ["Nutcracker Syndrome", "Left renal vein compression"],
    ["Sickle Cell Disease/Trait", "Papillary necrosis, sickling"],
    ["Benign Idiopathic Urethrorrhagia", "Prepubertal boys, blood spots in underwear"],
  ];

  const cols = [grossCauses.slice(0, 6), grossCauses.slice(6)];
  cols.forEach((col, ci) => {
    col.forEach((item, ri) => {
      const x = ci === 0 ? 0.25 : 5.15;
      const y = 1.45 + ri * 0.64;
      const bg = ri % 2 === 0 ? "FFFFFF" : C.lightGray;
      addBox(s, x, y, 4.7, 0.58, bg, "D5D8DC");
      s.addText(item[0], { x: x + 0.1, y: y + 0.04, w: 4.5, h: 0.28, fontSize: 10.5, bold: true, color: C.navy, valign: "top" });
      s.addText(item[1], { x: x + 0.1, y: y + 0.3, w: 4.5, h: 0.24, fontSize: 9, color: C.midGray, valign: "top" });
    });
  });

  addFooter(s, "Campbell-Walsh-Wein Urology | Diven & Travis, 2000");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — Causes of Microscopic Hematuria
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "ETIOLOGY");
  addTitleBar(s, "Causes of Microscopic Hematuria", "Broad differential — definitive diagnosis in <30%");

  const microGroups = [
    { label: "Glomerular", color: C.teal, items: ["Thin Basement Membrane Disease", "IgA Nephropathy", "Alport Syndrome", "Post-infectious GN", "Lupus Nephritis", "MPGN"] },
    { label: "Non-Glomerular", color: C.blue, items: ["Hypercalciuria / Nephrolithiasis", "UTI / Pyelonephritis", "Congenital Anomalies (CAKUT)", "Exercise-induced", "Drugs / Interstitial Nephritis", "Sickle Cell Disease/Trait"] },
    { label: "Other", color: C.midGray, items: ["Transient (fever, vigorous exercise)", "Benign Familial Hematuria", "Protein overload syndromes", "Hemolysis / Rhabdomyolysis", "Hypergammaglobulinemia"] },
  ];

  microGroups.forEach((grp, gi) => {
    const x = 0.2 + gi * 3.27;
    addBox(s, x, 1.42, 3.0, 0.44, grp.color, grp.color);
    s.addText(grp.label, { x, y: 1.42, w: 3.0, h: 0.44, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    grp.items.forEach((item, ii) => {
      const bg = ii % 2 === 0 ? "FFFFFF" : C.lightGray;
      addBox(s, x, 1.86 + ii * 0.56, 3.0, 0.52, bg, "D5D8DC");
      s.addText(item, { x: x + 0.12, y: 1.9 + ii * 0.56, w: 2.8, h: 0.44, fontSize: 10, color: C.navy, valign: "middle" });
    });
  });

  addFooter(s, "Campbell-Walsh-Wein Urology | Pediatric Nephrology BOX 21.1");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — History Taking
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "CLINICAL EVALUATION");
  addTitleBar(s, "History Taking", "A systematic and detailed history guides the entire work-up");

  const histBlocks = [
    {
      title: "CHIEF COMPLAINT",
      color: C.navy,
      items: ["Duration: acute vs. chronic/intermittent", "Gross vs. microscopic (dipstick vs. naked eye)", "Color: red (lower tract) vs. tea/cola (glomerular)", "Timing: initial, terminal, or total stream"]
    },
    {
      title: "ASSOCIATED SYMPTOMS",
      color: C.teal,
      items: ["Fever → UTI, post-infectious GN", "Dysuria, frequency → UTI", "Flank / abdominal pain → stones, trauma, thrombosis", "Rash, joint pain → HSP, SLE", "Headache, visual changes, edema → hypertension / nephritic syndrome", "Weight gain, periorbital puffiness → nephrotic"]
    },
    {
      title: "FAMILY HISTORY",
      color: C.blue,
      items: ["Hematuria (thin BM disease, Alport)", "Hearing loss (Alport syndrome)", "Nephrolithiasis (urolithiasis)", "Sickle cell disease / trait", "Renal disease / ESRD", "Bleeding disorders / coagulopathy"]
    },
    {
      title: "MEDICAL / DRUG HISTORY",
      color: C.midGray,
      items: ["Recent throat / skin infection → ASO / APSGN", "Recent URTI → IgA nephropathy", "Vigorous exercise → exercise hematuria", "Medications (NSAIDs, cyclophosphamide)", "History of trauma (recent or remote)"]
    }
  ];

  histBlocks.forEach((blk, bi) => {
    const x = bi < 2 ? 0.2 + bi * 4.9 : 0.2 + (bi - 2) * 4.9;
    const y = bi < 2 ? 1.45 : 3.35;
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    s.addText(blk.title, { x, y, w: 4.6, h: 0.38, fontSize: 10.5, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    addBox(s, x, y + 0.38, 4.6, 1.42, "FFFFFF", "D5D8DC");
    s.addText(bulletsText(blk.items, { fontSize: 9.5, color: C.navy }), { x: x + 0.1, y: y + 0.42, w: 4.4, h: 1.35 });
  });

  addFooter(s, "Campbell-Walsh-Wein Urology | Pediatric Nephrology Chapter");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — Physical Examination
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "CLINICAL EVALUATION");
  addTitleBar(s, "Physical Examination", "Findings that direct the differential diagnosis");

  const examItems = [
    { icon: "BP", label: "Blood Pressure", detail: "Hypertension → glomerulonephritis, renal parenchymal disease, renal artery involvement" },
    { icon: "WT", label: "Weight / Edema", detail: "Peripheral edema, periorbital puffiness, ascites → nephritic or nephrotic syndrome" },
    { icon: "SKN", label: "Skin / Rash", detail: "Palpable purpura (legs, buttocks) → IgA Vasculitis (HSP) | Butterfly rash → SLE" },
    { icon: "JNT", label: "Joints", detail: "Arthritis / arthralgia → HSP, SLE, systemic vasculitis" },
    { icon: "ABD", label: "Abdomen / Flanks", detail: "Abdominal mass → Wilms tumor | Flank tenderness → pyelonephritis, stone, trauma | Renal bruit → AV fistula" },
    { icon: "EAR", label: "Hearing (ENT)", detail: "Sensorineural hearing loss → Alport syndrome (X-linked COL4A5 mutation)" },
    { icon: "GEN", label: "Genitalia / Perineum", detail: "Perineal irritation, meatal abnormalities, urethral discharge → local causes of gross hematuria" },
    { icon: "EYE", label: "Eyes", detail: "Anterior lenticonus → Alport syndrome | Retinal changes → severe hypertension or SLE" },
  ];

  examItems.forEach((item, i) => {
    const col = i < 4 ? 0 : 1;
    const row = i % 4;
    const x = 0.2 + col * 5.0;
    const y = 1.45 + row * 1.0;
    addBox(s, x, y, 0.72, 0.72, C.teal, C.teal);
    s.addText(item.icon, { x, y, w: 0.72, h: 0.72, fontSize: 8, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    addBox(s, x + 0.72, y, 4.1, 0.72, i % 2 === 0 ? "FFFFFF" : C.lightGray, "D5D8DC");
    s.addText(item.label, { x: x + 0.82, y: y + 0.04, w: 3.9, h: 0.28, fontSize: 10.5, bold: true, color: C.navy });
    s.addText(item.detail, { x: x + 0.82, y: y + 0.32, w: 3.9, h: 0.38, fontSize: 9, color: C.midGray });
  });

  addFooter(s, "Campbell-Walsh-Wein Urology | Pediatric Nephrology Chapter");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — Urinalysis & Urine Microscopy
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "INVESTIGATIONS — STEP 1");
  addTitleBar(s, "Urinalysis & Urine Microscopy", "The single most critical step in evaluation of hematuria");

  // Central importance box
  addBox(s, 0.25, 1.45, 9.5, 0.55, C.lightGold, C.gold);
  s.addText("ALWAYS examine a FRESHLY VOIDED urine sample with microscopic assessment — this is the critical first step", {
    x: 0.35, y: 1.45, w: 9.3, h: 0.55, fontSize: 11, bold: true, color: C.navy, valign: "middle", italic: true
  });

  const uaRows = [
    { test: "Dipstick Heme +, no RBCs on microscopy", interpretation: "Hemoglobinuria (hemolysis) or Myoglobinuria (rhabdomyolysis)", color: "FFE8D4" },
    { test: "Normal RBC morphology (isomorphic)", interpretation: "Non-glomerular origin → lower urinary tract, stones, infection, trauma", color: "D4EEF1" },
    { test: "Dysmorphic / crenated RBCs (acanthocytes)", interpretation: "Glomerular origin → GN, thin BM disease, Alport", color: "D4F0D4" },
    { test: "RBC casts in sediment", interpretation: "PATHOGNOMONIC of glomerulonephritis — defines nephritic syndrome", color: "FCF0D5" },
    { test: "WBCs / bacteria", interpretation: "Urinary tract infection → send urine culture", color: "ECDDF5" },
    { test: "Crystals (calcium oxalate, uric acid)", interpretation: "Urolithiasis / hypercalciuria — consider 24h urine calcium", color: "D4EEF1" },
    { test: "Proteinuria (dipstick 2+ or higher)", interpretation: "Glomerular disease — quantify with urine protein:creatinine ratio", color: "FFE8D4" },
  ];

  uaRows.forEach((row, i) => {
    addBox(s, 0.25, 2.08 + i * 0.49, 4.5, 0.45, row.color, "C0C0C0");
    s.addText(row.test, { x: 0.35, y: 2.1 + i * 0.49, w: 4.3, h: 0.41, fontSize: 9.5, bold: true, color: C.navy, valign: "middle" });
    addBox(s, 4.75, 2.08 + i * 0.49, 5.0, 0.45, row.color, "C0C0C0");
    s.addText(row.interpretation, { x: 4.85, y: 2.1 + i * 0.49, w: 4.8, h: 0.41, fontSize: 9.5, color: C.navy, valign: "middle" });
  });

  s.addText("FINDING", { x: 0.25, y: 1.98, w: 4.5, h: 0.1, fontSize: 9, bold: true, color: C.teal, align: "center" });
  s.addText("INTERPRETATION", { x: 4.75, y: 1.98, w: 5.0, h: 0.1, fontSize: 9, bold: true, color: C.teal, align: "center" });

  addFooter(s, "Campbell-Walsh-Wein Urology | Feld et al., 1998");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — Glomerular vs Non-Glomerular Hematuria
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "CLINICAL DIFFERENTIATION");
  addTitleBar(s, "Glomerular vs. Non-Glomerular Hematuria", "Key clinical and laboratory distinguishing features");

  const rows = [
    ["Feature", "Glomerular", "Non-Glomerular"],
    ["Urine color", "Tea / cola / brown colored", "Red / pink / bright red"],
    ["RBC morphology", "Dysmorphic, acanthocytes", "Isomorphic (normal)"],
    ["RBC casts", "Present (pathognomonic)", "Absent"],
    ["Proteinuria", "Often significant (2+ or more)", "Absent or trace"],
    ["Hypertension", "Common", "Rare (unless underlying cause)"],
    ["Edema", "May be present", "Absent"],
    ["Pain", "Rarely painful", "Often painful (stones, UTI, trauma)"],
    ["Common causes", "GN, thin BM disease, Alport, IgA", "UTI, stones, trauma, tumor"],
  ];

  rows.forEach((row, ri) => {
    const isHeader = ri === 0;
    const bg0 = isHeader ? C.navy : (ri % 2 === 0 ? "FFFFFF" : C.lightGray);
    const bg1 = isHeader ? C.red : (ri % 2 === 0 ? "FDDBD8" : "FADBD8");
    const bg2 = isHeader ? C.teal : (ri % 2 === 0 ? C.lightTeal : "C8E4EA");
    const fsize = isHeader ? 10.5 : 10;
    const textCol = isHeader ? C.white : C.navy;
    const y = 1.42 + ri * 0.46;
    addBox(s, 0.2, y, 2.8, 0.44, bg0, "C0C0C0");
    addBox(s, 3.0, y, 3.3, 0.44, bg1, "C0C0C0");
    addBox(s, 6.3, y, 3.45, 0.44, bg2, "C0C0C0");
    s.addText(row[0], { x: 0.28, y: y + 0.04, w: 2.65, h: 0.36, fontSize: fsize, bold: isHeader, color: textCol, valign: "middle" });
    s.addText(row[1], { x: 3.08, y: y + 0.04, w: 3.15, h: 0.36, fontSize: fsize, bold: isHeader, color: textCol, valign: "middle" });
    s.addText(row[2], { x: 6.38, y: y + 0.04, w: 3.28, h: 0.36, fontSize: fsize, bold: isHeader, color: textCol, valign: "middle" });
  });

  addFooter(s, "Campbell-Walsh-Wein Urology | Pediatric Nephrology Chapter");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — Laboratory Investigations
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "INVESTIGATIONS — STEP 2");
  addTitleBar(s, "Laboratory Investigations", "Tailored to history, examination, and urinalysis findings");

  // 3-column approach
  const labCols = [
    {
      title: "INITIAL WORKUP\n(ALL patients)",
      color: C.navy,
      items: [
        "Urinalysis with microscopy",
        "Urine culture (if UTI suspected)",
        "Urine protein:creatinine ratio",
        "Blood pressure measurement",
        "Renal ultrasonography"
      ]
    },
    {
      title: "GLOMERULAR PANEL\n(if glomerular features)",
      color: C.teal,
      items: [
        "Serum creatinine, electrolytes, BUN",
        "Serum albumin",
        "CBC with differential",
        "C3 and C4 complement levels",
        "ASO / anti-DNase B titres (APSGN)",
        "ANA screening (if SLE suspected)",
        "ANCA (if vasculitis suspected)"
      ]
    },
    {
      title: "UROLOGICAL PANEL\n(if non-glomerular features)",
      color: C.blue,
      items: [
        "24h urine calcium (hypercalciuria)",
        "Spot urine calcium:creatinine ratio",
        "Urine culture and sensitivity",
        "Serum uric acid",
        "Sickle cell screen (if indicated)",
        "PT / PTT / bleeding time (coagulopathy)",
        "CT KUB (stone protocol if needed)"
      ]
    }
  ];

  labCols.forEach((col, ci) => {
    const x = 0.2 + ci * 3.27;
    addBox(s, x, 1.42, 3.0, 0.72, col.color, col.color);
    s.addText(col.title, { x: x + 0.05, y: 1.42, w: 2.9, h: 0.72, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle" });
    col.items.forEach((item, ii) => {
      const bg = ii % 2 === 0 ? "FFFFFF" : C.lightGray;
      addBox(s, x, 2.14 + ii * 0.48, 3.0, 0.46, bg, "D5D8DC");
      s.addText("• " + item, { x: x + 0.1, y: 2.18 + ii * 0.48, w: 2.8, h: 0.38, fontSize: 9.5, color: C.navy, valign: "middle" });
    });
  });

  addFooter(s, "Campbell-Walsh-Wein Urology | Pediatric Nephrology Chapter");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — Imaging
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "INVESTIGATIONS — STEP 3");
  addTitleBar(s, "Imaging in Pediatric Hematuria", "First-line modality: renal ultrasonography (no radiation)");

  const imgData = [
    {
      modality: "Renal Ultrasound",
      color: C.teal,
      badge: "FIRST LINE",
      badgeColor: C.gold,
      indications: "All children with gross hematuria, suspected stones, masses, structural anomalies, or glomerular disease",
      detects: "Stones, hydronephrosis, CAKUT, cystic kidneys (PKD), renal masses, renal vein thrombosis"
    },
    {
      modality: "CT Abdomen/Pelvis",
      color: C.navy,
      badge: "TRAUMA / STONE",
      badgeColor: C.red,
      indications: "Gross hematuria + trauma | Suspected nephrolithiasis (non-contrast CT) | ≥50 RBC/hpf after trauma",
      detects: "Renal lacerations, contusions, vascular injury, stone location and size, tumor extent"
    },
    {
      modality: "VCUG",
      color: C.blue,
      badge: "STRUCTURAL",
      badgeColor: C.blue,
      indications: "Recurrent UTI with structural concern, VUR evaluation, bladder outflow obstruction",
      detects: "Vesicoureteral reflux grade, posterior urethral valves, bladder diverticula"
    },
    {
      modality: "Cystoscopy",
      color: C.midGray,
      badge: "PERSISTENT",
      badgeColor: C.midGray,
      indications: "Persistent gross hematuria without identifiable cause after US + labs",
      detects: "Bladder lesions, bleeding sites, ureteral orifice abnormalities; rarely needed in children"
    }
  ];

  imgData.forEach((item, i) => {
    const x = i < 2 ? 0.2 + i * 4.9 : 0.2 + (i - 2) * 4.9;
    const y = i < 2 ? 1.42 : 3.4;
    addBox(s, x, y, 4.6, 0.38, item.color, item.color);
    s.addText(item.modality, { x: x + 0.08, y, w: 3.4, h: 0.38, fontSize: 11, bold: true, color: C.white, valign: "middle" });
    addBox(s, x + 3.5, y + 0.06, 1.0, 0.26, item.badgeColor, item.badgeColor);
    s.addText(item.badge, { x: x + 3.5, y: y + 0.06, w: 1.0, h: 0.26, fontSize: 7.5, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    addBox(s, x, y + 0.38, 4.6, 1.58, "FFFFFF", "D5D8DC");
    s.addText("Indicated when:", { x: x + 0.1, y: y + 0.42, w: 4.4, h: 0.24, fontSize: 9.5, bold: true, color: C.teal });
    s.addText(item.indications, { x: x + 0.1, y: y + 0.62, w: 4.4, h: 0.58, fontSize: 9, color: C.navy });
    s.addText("Detects:", { x: x + 0.1, y: y + 1.18, w: 4.4, h: 0.22, fontSize: 9.5, bold: true, color: C.teal });
    s.addText(item.detects, { x: x + 0.1, y: y + 1.38, w: 4.4, h: 0.5, fontSize: 9, color: C.midGray });
  });

  addFooter(s, "Harriet Lane Handbook 23e | Campbell-Walsh-Wein Urology");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — Age-Based Glomerular Disease
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "GLOMERULAR CAUSES — AGE-BASED APPROACH");
  addTitleBar(s, "Glomerular Disease by Age Group", "BOX 21.3 – Campbell-Walsh-Wein Urology");

  const ageGroups = [
    {
      label: "< 1 YEAR",
      color: C.red,
      diseases: [
        "Congenital infections",
        "Diffuse mesangial sclerosis",
        "Congenital nephrotic syndrome",
        "Infantile nephrotic syndrome",
        "Denys-Drash syndrome",
        "Frasier syndrome",
        "Genetic renal diseases",
      ]
    },
    {
      label: "1 – 10 YEARS",
      color: C.teal,
      diseases: [
        "Post-streptococcal GN (APSGN)",
        "Minimal Change Nephrotic Syndrome",
        "Focal Segmental Glomerulosclerosis",
        "IgA Vasculitis (HSP)",
        "Hemolytic Uremic Syndrome",
        "Alport Syndrome",
        "Thin BM nephropathy",
      ]
    },
    {
      label: "≥ 7 YEARS",
      color: C.navy,
      diseases: [
        "Systemic Lupus Erythematosus",
        "Systemic Vasculitis / ANCA",
        "IgA Nephropathy",
        "Membranoproliferative GN",
        "Membranous Nephropathy",
        "Crescentic (Rapidly Progressive) GN",
        "Secondary FSGS",
      ]
    }
  ];

  ageGroups.forEach((grp, gi) => {
    const x = 0.2 + gi * 3.27;
    addBox(s, x, 1.42, 3.0, 0.52, grp.color, grp.color);
    s.addText(grp.label, { x, y: 1.42, w: 3.0, h: 0.52, fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    grp.diseases.forEach((d, di) => {
      const bg = di % 2 === 0 ? "FFFFFF" : C.lightGray;
      addBox(s, x, 1.94 + di * 0.52, 3.0, 0.5, bg, "D5D8DC");
      s.addText("• " + d, { x: x + 0.1, y: 1.98 + di * 0.52, w: 2.8, h: 0.42, fontSize: 10, color: C.navy, valign: "middle" });
    });
  });

  addFooter(s, "Campbell-Walsh-Wein Urology BOX 21.3 — Common Age Ranges for Glomerular Diseases");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — Approach Algorithm (Flowchart-style)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: "1A2A3A" }, line: { color: "1A2A3A" } });
  addSectionBanner(s, "DIAGNOSTIC ALGORITHM");
  s.addText("Stepwise Approach to Hematuria in Pediatrics", { x: 0.2, y: 0.35, w: 9.6, h: 0.72, fontSize: 20, bold: true, color: C.white, valign: "middle" });

  // Step boxes
  const steps = [
    { num: "1", label: "CONFIRM HEMATURIA", sub: "UA + urine microscopy (freshly voided)\n>5 RBC/hpf on 2+ occasions", color: C.teal, x: 0.2, y: 1.15 },
    { num: "2", label: "RULE OUT PSEUDOHEMATURIA", sub: "Dipstick+ but no RBCs → Hb/Mb\nDrugs, foods (beets, rifampicin)", color: C.midGray, x: 3.55, y: 1.15 },
    { num: "3", label: "GLOMERULAR vs NON-GLOMERULAR", sub: "RBC morphology, casts, proteinuria,\nurine color, hypertension", color: C.navy, x: 6.9, y: 1.15 },
  ];

  steps.forEach(st => {
    addBox(s, st.x, st.y, 3.1, 1.5, st.color, st.color);
    s.addText(st.num, { x: st.x, y: st.y, w: 0.5, h: 0.5, fontSize: 14, bold: true, color: C.gold, align: "center", valign: "middle" });
    s.addText(st.label, { x: st.x + 0.08, y: st.y + 0.5, w: 2.94, h: 0.36, fontSize: 10, bold: true, color: C.white, align: "center" });
    s.addText(st.sub, { x: st.x + 0.1, y: st.y + 0.85, w: 2.9, h: 0.6, fontSize: 8.5, color: C.lightGray, align: "center" });
  });

  // Arrows
  s.addShape(pres.ShapeType.rightArrow, { x: 3.3, y: 1.6, w: 0.3, h: 0.5, fill: { color: C.gold }, line: { color: C.gold } });
  s.addShape(pres.ShapeType.rightArrow, { x: 6.65, y: 1.6, w: 0.3, h: 0.5, fill: { color: C.gold }, line: { color: C.gold } });

  // Step 4 & 5 side by side
  addBox(s, 0.2, 2.85, 4.6, 2.4, C.teal, C.teal);
  s.addText("4  GLOMERULAR WORKUP", { x: 0.25, y: 2.85, w: 4.5, h: 0.38, fontSize: 10.5, bold: true, color: C.white, valign: "middle" });
  const gl4 = ["C3, C4 complement levels", "ASO / anti-DNase B", "ANA, ANCA", "Serum Cr, albumin, CBC", "Renal biopsy if indicated", "Refer pediatric nephrology"];
  gl4.forEach((item, i) => {
    s.addText("• " + item, { x: 0.35, y: 3.28 + i * 0.33, w: 4.3, h: 0.3, fontSize: 9.5, color: C.white });
  });

  addBox(s, 5.15, 2.85, 4.6, 2.4, C.blue, C.blue);
  s.addText("5  NON-GLOMERULAR WORKUP", { x: 5.2, y: 2.85, w: 4.5, h: 0.38, fontSize: 10.5, bold: true, color: C.white, valign: "middle" });
  const ng5 = ["Urine culture (rule out UTI)", "24h urine calcium / Ca:Cr ratio", "Renal ultrasound (first-line imaging)", "CT scan if trauma or stones suspected", "Cystoscopy (persistent unexplained)", "Refer urology if structural cause"];
  ng5.forEach((item, i) => {
    s.addText("• " + item, { x: 5.25, y: 3.28 + i * 0.33, w: 4.35, h: 0.3, fontSize: 9.5, color: C.white });
  });

  // Down arrows
  s.addShape(pres.ShapeType.downArrow, { x: 2.4, y: 2.6, w: 0.5, h: 0.28, fill: { color: C.gold }, line: { color: C.gold } });
  s.addShape(pres.ShapeType.downArrow, { x: 7.1, y: 2.6, w: 0.5, h: 0.28, fill: { color: C.gold }, line: { color: C.gold } });

  addFooter(s, "Campbell-Walsh-Wein Urology | Pediatric Nephrology Reference");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — Specific Conditions: APSGN, IgA, HSP
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "KEY GLOMERULAR CONDITIONS");
  addTitleBar(s, "Common Glomerular Causes in Children", "APSGN • IgA Nephropathy • IgA Vasculitis (HSP)");

  const conditions = [
    {
      name: "APSGN",
      full: "Acute Post-Streptococcal GN",
      color: C.teal,
      age: "1–10 years",
      features: ["Tea-colored urine (nephritis)", "Hypertension, edema", "Preceding throat (1–3 wks) or skin (3–6 wks) infection", "↓ C3, normal C4", "↑ ASO / anti-DNase B titers"],
      management: "Supportive: antihypertensives, diuretics, salt restriction. Penicillin if active strep. Self-limiting."
    },
    {
      name: "IgA Nephropathy",
      full: "Berger Disease",
      color: C.blue,
      age: "Older children / teens",
      features: ["Synpharyngitic gross hematuria (during URTI)", "Recurrent episodes of gross hematuria", "Normal complement levels", "Biopsy: mesangial IgA deposits", "Variable proteinuria"],
      management: "ACE inhibitor if proteinuria. Omega-3, tonsillectomy debated. Immunosuppression for progressive disease."
    },
    {
      name: "IgA Vasculitis",
      full: "Henoch-Schonlein Purpura (HSP)",
      color: C.red,
      age: "2–10 years",
      features: ["Palpable purpura (legs, buttocks)", "Arthritis / arthralgia", "Abdominal pain", "Renal involvement: hematuria ± proteinuria", "Normal platelets / coagulation"],
      management: "Supportive. Steroids for severe abdominal pain / arthritis. Nephrology referral if significant nephritis."
    }
  ];

  conditions.forEach((cond, ci) => {
    const x = 0.2 + ci * 3.27;
    addBox(s, x, 1.42, 3.0, 0.55, cond.color, cond.color);
    s.addText(cond.name, { x, y: 1.42, w: 3.0, h: 0.3, fontSize: 12.5, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(cond.full, { x, y: 1.7, w: 3.0, h: 0.24, fontSize: 8.5, color: C.white, align: "center", italic: true });
    addBox(s, x, 1.97, 3.0, 0.25, C.lightGold, C.gold);
    s.addText("Age: " + cond.age, { x, y: 1.97, w: 3.0, h: 0.25, fontSize: 9, bold: true, color: C.navy, align: "center", valign: "middle" });
    s.addText("Key Features:", { x: x + 0.1, y: 2.25, w: 2.8, h: 0.24, fontSize: 9.5, bold: true, color: cond.color });
    cond.features.forEach((f, fi) => {
      s.addText("• " + f, { x: x + 0.1, y: 2.48 + fi * 0.3, w: 2.8, h: 0.27, fontSize: 9, color: C.navy });
    });
    addBox(s, x, 4.98, 3.0, 0.38, cond.color, cond.color);
    s.addText("Rx: " + cond.management.substring(0, 70) + "...", { x: x + 0.05, y: 4.98, w: 2.9, h: 0.38, fontSize: 8, color: C.white, valign: "middle" });
  });

  addFooter(s, "Campbell-Walsh-Wein Urology | Pediatric Nephrology Chapter BOX 21.3");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — Alport & Thin BM Disease
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "HEREDITARY NEPHROPATHIES");
  addTitleBar(s, "Alport Syndrome & Thin Basement Membrane Disease", "Hereditary causes of persistent microscopic hematuria");

  // Alport
  addBox(s, 0.2, 1.42, 4.65, 3.8, "FFFFFF", C.navy);
  addBox(s, 0.2, 1.42, 4.65, 0.45, C.navy, C.navy);
  s.addText("ALPORT SYNDROME", { x: 0.2, y: 1.42, w: 4.65, h: 0.45, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle" });
  const alportItems = [
    ["Genetics", "X-linked (80%) — COL4A5 mutation\nAutosomal recessive — COL4A3/A4"],
    ["Renal", "Persistent microscopic hematuria → progressive nephritis → ESRD (teens–young adult in males)"],
    ["Hearing", "Sensorineural hearing loss (bilateral, progressive)"],
    ["Eyes", "Anterior lenticonus, macular flecks"],
    ["EM", "GBM thinning + splitting ('basket-weave' lamellation)"],
    ["Management", "ACE inhibitors (delay progression)\nAvoid nephrotoxins\nGenetic counseling\nRenal transplant for ESRD"],
  ];
  alportItems.forEach((item, i) => {
    s.addText(item[0] + ":", { x: 0.3, y: 1.95 + i * 0.53, w: 1.1, h: 0.48, fontSize: 9.5, bold: true, color: C.navy, valign: "top" });
    s.addText(item[1], { x: 1.35, y: 1.95 + i * 0.53, w: 3.4, h: 0.48, fontSize: 9, color: C.midGray, valign: "top" });
  });

  // Thin BM
  addBox(s, 5.15, 1.42, 4.65, 3.8, "FFFFFF", C.teal);
  addBox(s, 5.15, 1.42, 4.65, 0.45, C.teal, C.teal);
  s.addText("THIN BASEMENT MEMBRANE DISEASE", { x: 5.15, y: 1.42, w: 4.65, h: 0.45, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
  const tbmItems = [
    ["Genetics", "Autosomal dominant\nHeterozygous COL4A3 or COL4A4"],
    ["Renal", "Isolated persistent microscopic hematuria\nBenign prognosis in most cases"],
    ["Family Hx", "Family history of microscopic hematuria (3–4 generations)"],
    ["EM", "Diffuse thinning of GBM (<200 nm)\nNo splitting or lamellation"],
    ["Hearing / Eyes", "Normal hearing and vision (unlike Alport)"],
    ["Management", "Observation and monitoring\nBP control if proteinuria develops\nAnnual follow-up with UA + BP"],
  ];
  tbmItems.forEach((item, i) => {
    s.addText(item[0] + ":", { x: 5.25, y: 1.95 + i * 0.53, w: 1.1, h: 0.48, fontSize: 9.5, bold: true, color: C.teal, valign: "top" });
    s.addText(item[1], { x: 6.3, y: 1.95 + i * 0.53, w: 3.4, h: 0.48, fontSize: 9, color: C.midGray, valign: "top" });
  });

  addFooter(s, "Campbell-Walsh-Wein Urology BOX 21.3 | Comprehensive Clinical Nephrology");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — Hypercalciuria & Nephrolithiasis
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "NON-GLOMERULAR — STONES & HYPERCALCIURIA");
  addTitleBar(s, "Hypercalciuria & Nephrolithiasis", "Most common metabolic cause of hematuria in children");

  addBox(s, 0.2, 1.42, 9.6, 0.62, C.lightGold, C.gold);
  s.addText("Hypercalciuria is the most common metabolic abnormality causing hematuria in children — present in up to 30% of cases of isolated microscopic hematuria", {
    x: 0.3, y: 1.42, w: 9.4, h: 0.62, fontSize: 11, italic: true, color: C.navy, valign: "middle"
  });

  const cols3 = [
    {
      title: "DIAGNOSIS",
      color: C.teal,
      items: [
        "Spot urine Ca:Cr ratio >0.2 mg/mg (children >2 yrs)",
        "24h urine calcium >4 mg/kg/day",
        "Family history of kidney stones",
        "Renal ultrasound (calculi, nephrocalcinosis)",
        "Plain abdominal X-ray (radiopaque stones)",
        "Non-contrast CT KUB (gold standard for stones)"
      ]
    },
    {
      title: "CLINICAL FEATURES",
      color: C.navy,
      items: [
        "Gross or microscopic hematuria",
        "Colicky flank / groin pain (older children)",
        "Dysuria, urgency, frequency",
        "Nausea, vomiting with renal colic",
        "Passage of stone / gravel in urine",
        "Younger children: irritability, vomiting"
      ]
    },
    {
      title: "MANAGEMENT",
      color: C.blue,
      items: [
        "Increase fluid intake (goal 2L/m²/day)",
        "Thiazide diuretics (idiopathic hypercalciuria)",
        "Low sodium diet (reduces Ca excretion)",
        "Low oxalate diet (calcium oxalate stones)",
        "Citrate supplementation (alkalinizes urine)",
        "Urological referral for obstructing stones"
      ]
    }
  ];

  cols3.forEach((col, ci) => {
    const x = 0.2 + ci * 3.27;
    addBox(s, x, 2.15, 3.0, 0.42, col.color, col.color);
    s.addText(col.title, { x, y: 2.15, w: 3.0, h: 0.42, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
    col.items.forEach((item, ii) => {
      const bg = ii % 2 === 0 ? "FFFFFF" : C.lightGray;
      addBox(s, x, 2.57 + ii * 0.48, 3.0, 0.46, bg, "D5D8DC");
      s.addText("• " + item, { x: x + 0.1, y: 2.6 + ii * 0.48, w: 2.8, h: 0.4, fontSize: 9.5, color: C.navy, valign: "middle" });
    });
  });

  addFooter(s, "Campbell-Walsh-Wein Urology | Pediatric Nephrology Reference");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — Red Flags & When to Refer
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
  addSectionBanner(s, "RED FLAGS & REFERRAL");
  addTitleBar(s, "Red Flags & When to Refer", "Features that require urgent nephrology or urology referral");

  // Red flags
  addBox(s, 0.2, 1.42, 9.6, 0.38, C.red, C.red);
  s.addText("RED FLAG FEATURES — Require Urgent Evaluation", {
    x: 0.2, y: 1.42, w: 9.6, h: 0.38, fontSize: 11.5, bold: true, color: C.white, align: "center", valign: "middle"
  });

  const redFlags = [
    ["Hypertension", "Suggests glomerular or renovascular disease"],
    ["Edema / Weight gain", "Nephrotic or nephritic syndrome"],
    ["Significant proteinuria", "Glomerular pathology — biopsy may be needed"],
    ["Impaired renal function", "Rapidly progressive GN — urgent biopsy"],
    ["RBC casts", "Pathognomonic glomerulonephritis"],
    ["Abdominal mass", "Wilms tumor — urgent imaging"],
    ["Clotting abnormality", "Bleeding diathesis — hematology referral"],
    ["Systemic features: rash, fever, arthritis", "SLE, HSP, vasculitis"],
  ];

  redFlags.forEach((rf, i) => {
    const col = i < 4 ? 0 : 1;
    const row = i % 4;
    const x = 0.2 + col * 4.9;
    const y = 1.88 + row * 0.55;
    addBox(s, x, y, 4.65, 0.5, i % 2 === 0 ? "FDDBD8" : "FAD7D5", C.red);
    s.addText(rf[0], { x: x + 0.1, y: y + 0.05, w: 2.0, h: 0.22, fontSize: 10, bold: true, color: C.red });
    s.addText(rf[1], { x: x + 0.1, y: y + 0.26, w: 4.4, h: 0.2, fontSize: 9, color: C.navy });
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  // Referral guidance
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  s.addText("REFERRAL GUIDANCE", { x: 0.3, y: 4.1, w: 9.4, h: 0.3, fontSize: 10.5, bold: true, color: C.teal });
  s.addText([
    { text: "Nephrology: ", options: { bold: true, color: C.teal, breakLine: false } },
    { text: "Glomerular features, proteinuria, hypertension, impaired GFR, systemic disease, RBC casts, hereditary nephropathy     ", options: { color: C.navy, breakLine: true } },
    { text: "Urology: ", options: { bold: true, color: C.blue, breakLine: false } },
    { text: "Persistent gross hematuria without apparent cause, suspected stones/obstruction, abdominal mass, structural anomalies, urethrorrhagia >2 years", options: { color: C.navy } }
  ], { x: 0.3, y: 4.4, w: 9.4, h: 0.85, fontSize: 10.5 });

  addFooter(s, "Campbell-Walsh-Wein Urology | Pediatric Nephrology Chapter");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 — Isolated Microscopic Hematuria: Management
// ══════════════════════════════════════════════════════════════════════════════
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  addSectionBanner(s, "MANAGEMENT");
  addTitleBar(s, "Managing Isolated Microscopic Hematuria", "A watchful waiting approach for asymptomatic children");

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  s.addText("In the absence of RBC casts, proteinuria, or family history of progressive renal disease — most patients may be OBSERVED and retested in 6–12 months", {
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    { step: "CONFIRM", detail: "Repeat UA x2 over 2–4 weeks to confirm persistence (>5 RBC/hpf both times)", color: C.teal },
    { step: "ASSESS", detail: "BP, urine protein:Cr ratio, family history, renal function baseline", color: C.navy },
    { step: "STRATIFY", detail: "Low risk: isolated, asymptomatic, no family history of ESRD\nHigh risk: + proteinuria, + hypertension, + family history of progressive renal disease", color: C.blue },
    { step: "FOLLOW-UP", detail: "Low risk: Annual review — UA, BP, growth monitoring, no biopsy needed\nHigh risk: Nephrology referral, consider biopsy", color: C.midGray },
  ];

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    s.addText(m.step, { x, y: 2.1, w: 2.1, h: 0.45, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });
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    s.addText(m.detail, { x: x + 0.08, y: 2.6, w: 1.95, h: 1.7, fontSize: 9.5, color: C.navy, valign: "top" });
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      s.addShape(pres.ShapeType.rightArrow, { x: x + 2.1, y: 2.25, w: 0.32, h: 0.35, fill: { color: C.gold }, line: { color: C.gold } });
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  addBox(s, 0.2, 4.52, 9.6, 0.78, C.lightTeal, C.teal);
  s.addText([
    { text: "When to consider RENAL BIOPSY: ", options: { bold: true, color: C.teal, breakLine: false } },
    { text: "Persistent proteinuria + hematuria | Declining GFR | Hypertension | Suspected IgA nephropathy, Alport, MPGN | Clinical features of systemic disease", options: { color: C.navy } }
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  addFooter(s, "Campbell-Walsh-Wein Urology | Feld et al., 1998");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 18 — Summary
// ══════════════════════════════════════════════════════════════════════════════
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  s.addText("Key Takeaways", { x: 0.3, y: 0.35, w: 9.4, h: 0.72, fontSize: 26, bold: true, color: C.white, valign: "middle" });

  s.addShape(pres.ShapeType.rect, { x: 0, y: 1.05, w: 10, h: 0.06, fill: { color: C.gold }, line: { color: C.gold } });

  const takeaways = [
    { n: "1", txt: "Hematuria = >5 RBCs/hpf on freshly spun urine on 2+ occasions. Confirm before extensive work-up." },
    { n: "2", txt: "Dipstick+ with no RBCs on microscopy → think hemoglobinuria or myoglobinuria, not true hematuria." },
    { n: "3", txt: "Determine glomerular vs. non-glomerular origin using RBC morphology, casts, and proteinuria." },
    { n: "4", txt: "Most common cause of gross hematuria in children: UTI (26%), followed by perineal irritation, trauma." },
    { n: "5", txt: "Isolated microscopic hematuria occurs in ~1% of school-age children and mostly resolves within 1 year." },
    { n: "6", txt: "Always measure blood pressure — hypertension narrows the differential toward glomerular or renovascular disease." },
    { n: "7", txt: "Renal ultrasound is the first-line imaging modality; reserve CT for trauma, stones, or tumor." },
    { n: "8", txt: "Refer to nephrology if: proteinuria, hypertension, impaired GFR, or glomerular features on UA." },
  ];

  takeaways.forEach((t, i) => {
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.35, w: 10, h: 0.275, fill: { color: C.teal }, line: { color: C.teal } });
  s.addText("Source: Campbell-Walsh-Wein Urology | Harriet Lane Handbook 23e | Pediatric Nephrology Reference", {
    x: 0.3, y: 5.35, w: 9.4, h: 0.275, fontSize: 8, color: C.white, valign: "middle", align: "center"
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}

// ── Write file ─────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/hematuria-peds-ppt/Pediatric_Hematuria.pptx" })
  .then(() => console.log("SUCCESS: File written"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });