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Objective:To investigate the clinical features of acute post-streptococcal glomerulonephritis (APSGN) and C 3 glomerulopathy (C 3G) in children, and to improve the understanding, diagnosis and treatment of C 3G in children with atypical APSGN. Methods:The clinical data of 100 children whose were clinically diagnosed with APSGN and admitted to the Beijing Children′s Hospital, Capital Medical University from January 2016 to December 2021 were collected and retrospectively analyzed.Seventy-three cases finally diagnosed with APSGN were included in the APSGN group and 27 cases with C 3G were classified into the C 3G group.The clinical manifestations, laboratory results, treatment and prognosis of the 2 groups of children were analyzed and compared by the t-test, Mann-Whitney U test and χ2 test. Results:Both APSGN and C 3G patients had a history of streptococcal infection at the early stage of the disease.There was no significant difference in the onset age and gender between the 2 groups (all P>0.05). The clinical manifestations of APSGN and C 3G at the early stage are sometimes difficult to distinguish.However, the incidence rates of gross hematuria (92.6%) and nephrotic proteinuria (66.7%) in the C 3G group were higher than those in the APSGN group (69.8%, 30.1%) ( χ2=5.583, 10.960; all P<0.05). The laboratory test results suggested that compared with the C 3G group, the APSGN group had higher albumin levels [(36.3±7.4) g/L vs.(28.9±6.8) g/L], but lower triglycerides [(1.2±0.6) mmol/L vs.(1.6±0.7) mmol/L], blood urea [(7.6±5.6) mmol/L vs.(14.7±16.3) mmol/L], blood creatinine [(66.2±45.2) μmol/L vs.(120.1±170.3) μmol/L], and urine protein levels [(43.5±58.5) g/24 h vs.(319.2±994.8) g/24 h] ( t=4.655, 2.738, 2.241, 1.624, 1.448; all P<0.05). As for treatment, the use rates of hormones and other immunosuppressants in the C 3G group were higher than those in the APSGN group (59.3% vs.12.3%, 29.6% vs.1.4%) ( χ2=23.15, 19.22; all P<0.05). The follow-up data revealed that compared with the APSGN group, the C 3G group took a longer time for gross hematuria and microscopic hematuria symptoms to disappear, proteinuria test to turn negative and complement C 3 to recover [51.1(14.3, 90.0) d vs.14.9(6.0, 15.5) d; 218.3(60.0, 277.5) d vs.65.5(27.0, 82.5) d; 127.9(60.0, 180.0) d vs.38.2(13.0, 53.6) d; 129.3(55.5, 225.0) d vs.39.1(24.0, 51.0) d] ( U=2.395, 2.730, 2.890, 3.054; all P<0.05). Conclusions:APSGN children with relatively severe clinical manifestations during the acute stage, especially with unrelieved nephrotic proteinuria, should be highly suspected with C 3G.Such patients should be treated with steroids and undergo renal biopsy and complement investigation if necessary, so as to identify the cause early, adjust the treatment and improve their prognosis.
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We wanted to study the clinical and aetiological profile of hypertension in children and compare the results with previous studies done in paediatric hypertension among children between 3 and 15 years of age. METHODSAll children between 3 and 15 years of age who visited the Outpatient & Inpatient Department of Paediatrics, SAIMS were screened for the presence of hypertension. Systematic investigations were done to find out the aetiology of hypertension. RESULTSMaximum number of patients were in the age group of 3 to 9 years, followed by 12 to 15 years and 9 to 12 years age groups. Males were affected more. Nephrotic syndrome was the commonest cause of hypertension in children. CONCLUSIONSIn this study, it has been observed that minimum number of patients were in age group 9 - 12 years patients (19.3 %) and maximum number of patients were in the age group 3 - 9 years (51.6 %) with a M : F ratio of 1 : 0.93. and the main aetiology of hypertension was found to be nephrotic syndrome.
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Background: The aim of this study is to estimate the incidence and prognosis of PIGN in Eastern Province ofSaudi Arabia. Materials and Methods: We retrospectively collected the data of all subjects who were diagnosedand got admitted with PIGN in King Fahd hospital, Al Khobar, Saudi Arabia, reviewed and approved byInstitutional Review Board at Imam Abdulrahman Bin Faisal University. Result: Fifteen subjects were identifiedwith PIGN during the study period (2009-2018). All subjects were Saudi. The mean age was 7.27 years and themajority were males (53.3%). Eleven subjects (73.3%) had recent history of URTI, eleven subjects (73.3%) hadhistory of gross hematuria, nine subjects (60%) had history of eye puffiness, thirteen subjects (86.7%) had edema,and eight subjects (53.3%) had a fever at presentation. BP was elevated in eleven subjects (73.3%). All subjects(100%) had microscopic hematuria, urine protein to creatinine ratio was elevated in twelve subjects (median 13),ASO titer was elevated in five subjects (62.5%), C3 was decreased in twelve subjects (80%), serum albumin waslow in 12 subjects (85.7%), and ANA, IgA and C4 were normal in all tested subjects. Renal biopsy was performedin two subjects and the results confirmed the diagnosis of PIGN. Conclusion: The incidence of PIGN in ourpediatric population at King Fahd University Hospital in the period from 2009-2018 was 3 cases per 100000which indicate that (PIGN) in pediatric age group in the Eastern Province of Saudi Arabia is as common as inthe developed countries.
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Reversible posterior leukoencephalopathy syndrome is characterized by an acute, usually reversible encephalopathy, with radiological findings that mainly involve the white or grey matter of the parieto-occipital lobes. We report a case of post streptococcal glomerulonephritis presenting as reversible leukoencephalopathy syndrome. Immediate control of hypertension resulted in rapid and complete neurological recovery.
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Acute post-streptococcal glomerulonephritis (PSGN) is characterized by an abrupt onset of edema, hypertension, and hematuria. Life-threatening diffuse alveolar hemorrhage (DAH) is rarely associated with acute PSGN. There have been only two reported cases worldwide, and no case has been reported previously in Korea. Here, we present a patient who clinically presented with pulmonary-renal syndrome; the renal histology revealed post-infectious glomerulonephritis of immune complex origin. A 59-yr-old woman was admitted with oliguria and hemoptysis two weeks after pharyngitis. Renal insufficiency rapidly progressed, and respiratory distress developed. Chest radiography showed acute progressive bilateral pulmonary infiltrates. The clinical presentation suggested DAH with PSGN. Three days after treatment with high-dose steroids, the respiratory distress and pulmonary infiltrates resolved. Electron microscopy of a renal biopsy specimen sample revealed diffuse proliferative glomerulonephritis with characteristic subendothelial deposits of immune complex ("hump''). The renal function of the patient was restored, and the serum creatinine level was normalized after treatment.