Acute glomerulonephritis is a common disease in children and it is one of the diseases that are presented commonly with hematuria which means red urine (blood in urine).

Hematuria is the commonest presentation but not the only one. There are many other causes for hematuria in children that has to be differentiated from the topic of this article which is : Acute Post Streptococcal Glomerulonephritis in children which occurs after a streptococcal throat infection (sore throat with exudates or pus,congested throat, enlarged lymph nodes in the neck and may be a membrane on the tonsills).

Characters of post streptococcal glomerulonephritis : (the typical presentation):

  • History of strptococcal throat infection within the past 5 days to weeks (a latent period as immune reaction takes time to occur) or laboratory evidence of the infection if history is not available.
  • No history of previous renal disease.
  • No family history of renal diseases.
  • Red urine described as smoky coca-cola like colour (hematuria). This is also associated with oliguria (reduced amount of urine)
  • Hypertension occurs in 70% of cases and it rises all of a sudden and may also suddenly drop back to normal and so on. Hypertension needs early managment and proper treatment and it's the cause of most the complications associated with the disease.
  • Edema. It starts in the eyes as puffy eye lids in the morning (puffy eyes) and it may progress to edema of the limbs but most of the time edema is not marked.
  • Complications include hypertensive encephalopathy, heart failure and elecvtrolyte disturbances.
95% of the cases recover completely and the disease never recurs in the same child. Only a little proportion of the cases develope renal failure or chronicity.

Investigations:
-Urine examination shows:
  • RBCs casts.
  • Distorted shape of RBCs in urine (more than 5/HPF).
-Blood examination shows the following:
  • Elevated ESR and CRP.
  • Low levels of C3 and C4.
  • Normocytic normochromic anemia.
-Impaired glomerular function of the kidney.

Biopsy is insicated in resistant cases or in cases with atypical presentation (absence of the laboratory signs or clinical manifestations e.g.(normal C3 levels, history of renal disease, severe proteinuria in the nephrotic range)
Also, investigations should be done to exclude other causes of hematuria such as:

  • ANA to exclude SLE.
  • Ultrasound to exclude renal stones.
  • Urine analysis and hearing tests with family history taking to exclude Alport syndrome.
Treatment of Acute Glomerulonephritis in children :

  • Hospital admission to monitor blood pressure changes.
  • Salt and fluid restriction if needed (in marked edema, oliguria and H.F.)
  • Antibiotic therapy to eradicate infection (long acting Penicillin, one dose intramuscular, dose is calculated according to the age).
  • Treatment of hypertension using diuretics, ACE inhibitors and calcium channel blockers. Other complications such as renal failure, heart failure and electrolytes disturbances should be treated immediately.
  • Follow up according to the doctor's instructions.
image source:
http://www.flickr.com/photos/spigoo/65405098/



9 comments:

beulah williams said...

am a medical student here in nigeria,this article was realy helpful to me cos right now am doing my pediatric posting and i just needed a precise text about AGN.

Mezo said...

thnaks alot
im glad it helped

montu said...

thanks a lot as i am a mediclaim processer and its really useful to me as i have a similar case file...

thanks a lot
dr ankur shah
+91-9426284718

rodel said...

thanks a lot...it really helps me better understand bout the realted disease. Godbless

rodel romines
mobile #:+6309085630678

hidayahmiamir said...

sorry...i would like to ask...how child can easily get this agn???
i don't understand why..i mean, why post stretopcoccal infectious mde this agn???what's happen at the kidney?

Asenath said...

am a registered nurse/midwife here in nigeria,recently managing patient in the paediatric unit diagnosed with AGN.Thanks for your post,i would love if you can give a comprehensive management of this condition in the area of diet and any other helpful tips.

Abi said...

I am a health officer student in Ethiopia. The article you poseted helped a lot it is short and consice. Please keep up.
Aby

raju said...

RELLY IT IS VERY GOOD INFORMATION .MY DAUGHTER IS SUFFERING FROM THIS DISEASE.

Anonymous said...

precice and to the point,keep up mezo
this is great am a medical student in kenya and it realy helped