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Introduction: Acute glomerulonephritis is the most common reversible cause of kidney disease in children. Although most common presentations are oedema, hypertension, haematuria and oliguria, glomerulonephritis may manifest with atypical features. The aim of the study was to evaluate the Aims and objectives: frequency of various clinical manifestations of glomerulonephritis and to identify various abnormalities in laboratory pro?le in children with glomerulonephritis. 30 children admitted in paediatric department, King George Materials and methods: Hospital, Visakhapatnam with clinical features of glomerulonephritis were enrolled into the study . Data on clinical features, laboratory parameters and outcome was recorded. Males were more commonly affected. Majority were in the age Results: group of 9-12 years. Most common presentation was facial puf?ness. Atypical presentations were observed in 40% cases. Anaemia was observed in 50% cases. Hypertension was seen in 56% of cases. PSGN was commonest cause of AGN. Hypocomplementemia was seen in 80% cases. Even though most children with acute glomerulonephritis present Conclusion: with common clinical features, early identi?cation of atypical presentations of acute glomerulonephritis should be emphasised as their prompt recognition can lead to reduction in mortality
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Background: Acute glomerulonephritis (AGN), the commonest of which is acute post streptococcal glomerulonephritis, is common in school aged children and typically presents with haematuria, oedema, oliguria and varying degrees of renal insufficiency. This study evaluated epidemiologic factors, presentations and treatment outcome of AGN patients at University of Uyo Teaching Hospital, (UUTH), Uyo, Nigeria.Methods: This cross-sectional study was conducted among children with AGN at the paediatric nephrology unit of UUTH from January 2015 to December 2019. Data were analysed with statistical package for social sciences version 25 and p values <0.05 were considered statistical significant.Results: Fifteen out of 12,403 paediatric admissions had AGN, giving an average yearly hospital incidence of 3/year and 0.12% of total admission. Age range was three to 15 years. Mean age was 8.07±3.94 years and median was 7.00 years. Males were nine with a male/female ratio of 1.5:1. Eight (53.3%) belonged to the lowest socioeconomic class. Haematuria and peripheral oedema were universal presentations and 4 (26.7%) had antecedent pharyngeal infection. Other clinical presentations were: Oliguria 11(73.3%), Grade II hypertension 10 (66.7%), and pulmonary oedema 5 (33.3%). Four (26.7%) each had acute kidney injury, hyperkalaemia and dipstick massive proteinuria. Other complications were congestive cardiac failure 2 (13.3%), and seizures with encephalopathy in 1 (6.7%). Proteinuria was significantly associated with age at p=0.034 (Fisher Exact test). Major treatment modalities were: fluid management, loop diuretics and antibiotics as indicated.Conclusions: Short-term outcome was excellent with 100% discharge within 28 days of hospitalisation and the majority being discharged within two weeks.
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La glomerulonefritis aguda desencadenada por Streptococcus pneumoniae es una patología de baja prevalencia. Existen diversos reportes que comunican distintas cepas nefritogénicas; sin embargo, la 6C ha sido escasamente señalada como tal.Se presenta el caso de un paciente de 4 años, quien ingresó a Terapia Intensiva con pleuroneumonía por Streptococcus pneumoniae serotipo 6C y desarrolló, de modo concomitante, edemas, hipertensión arterial, hematuria, proteinuria, disminución del filtrado glomerular y del nivel de complemento C3. Se diagnosticó glomerulonefritis aguda. Su evolución fue satisfactoria en un breve plazo. Esta patología, por lo general, es de curso transitorio y benigno; sin embargo, en ocasiones, puede complicar la evolución de un paciente críticamente enfermo, por lo cual se hace necesario tenerla entre los diagnósticos diferenciales para considerar.
Acute glomerulonephritis caused by Streptococcuspneumoniaeis a low prevalence pathology. There are several reports communicating different nephritogenic serotypes, however, 6C has been scarcely indicated as such. It is presented the case of a 4-year-old patient who entered Intensive Therapy Unit with pleuropneumonia due to Streptococcuspneumoniae serotype 6C and concomitantly developed edemas, arterial hypertension, hematuria, proteinuria, decreased glomerular filtration rate and C3 complement level. Acute glomerulonephritis was diagnosed. His evolution was satisfactory in a short time. This pathology is usually of a transitory and benign course; however, sometimes it can potentially complicate the evolution of a critically ill patient, so it is necessary to have it among the differential diagnoses to consider.
Subject(s)
Humans , Male , Child, Preschool , Pleuropneumonia/diagnosis , Glomerulonephritis , Pleuropneumonia/drug therapy , Streptococcus pneumoniae , Diagnosis, DifferentialABSTRACT
Background@#Acute glomerulonephritis (AGN) occurs in all age groups and any settings around the world. AGN is a major cause of illness and death in children. However, the signs and symptoms are not specific for the disease.@*Objective@#To study the treatment and outcome of Acute Glomerulonephritis in children, at Pediatric ward, Mahosot Hospital@*Methodology@#A retrospective study was conducted to review the medical records of inpatients admitted to the Pediatric Ward at Mahosot Hospital from January 2014 to January 2017. All patients aged 15 years old or younger with complete medical records were included in the study. The information on signs and symptoms, laboratory results, treatment and outcome of the patients with acute glomerulonephritis were descriptively analyzed and reported.@*Finding@#There were 3,528 patients admitted to the Pediatric Ward at Mahosot Hospital during the three years. Among these, 64 patients were diagnosed as having AGN (1.81%), but only 36 cases met the study inclusion criteria. The proportion of males was slightly higher than females (ratio 1.2:1) with the mean (SD) age of 9.6 (±2.7 years old) years old. More than a half (53.57%) of the patients reported a medical history of pharyngitis or tonsillitis. The most common presenting symptoms and signs were edema (94%), hematuria (25%), anuria (36%) and hypertensive emergency (17%). The key abnormally elevated renal function tests included BUN (44%) and creatinine (28%). The most common complications included hypertensive encephalopathy (25%) and congestive heart failure (8%).@*Conclusion@#AGN is the major cause of acute kidney injury, congestive cardiac failure and hypertensive encephalopathy, which require optimal treatment in order to have a good outcome.
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Every cell of an organism is separated and protected by a cell membrane. It is proposed that harmony between intercellular communication and the health of an organism is controlled by a system, designated the protein-homeostasis-system (PHS). Kidneys consist of a variety of types of renal cells, each with its own characteristic cell-receptor interactions and producing characteristic proteins. A functional union of these renal cells can be determined by various renal function tests, and harmonious intercellular communication is essential for the healthy state of the host. Injury to a kind of renal cells can impair renal function and induce an imbalance in total body health. Every acute or chronic renal disease has unknown etiologic substances that are responsible for renal cell injury at the molecular level. The immune/repair system of the host should control the etiologic substances acting against renal cells; if this system fails, the disease progresses to end stage renal disease. Each renal disease has its characteristic pathologic lesions where immune cells and immune proteins, such as immunoglobulins and complements, are infiltrated. These immune cells and immune proteins may control the etiologic substances involved in renal pathologic lesions. Also, genetic renal diseases and cancers may originate from a protein deficiency or malfunctioning protein under the PHS. A unified pathogenesis for renal diseases, including acute glomerulonephritis, idiopathic nephrotic syndrome, immunoglobulin A nephropathy, genetic renal diseases such as Alport syndrome, and malignancies such as Wilms tumor and renal cell carcinoma, is proposed using the PHS hypothesis.
Subject(s)
Carcinoma, Renal Cell , Cell Membrane , Complement System Proteins , Glomerulonephritis , Glomerulonephritis, IGA , Hydrogen-Ion Concentration , Immunoglobulins , Kidney Diseases , Kidney Failure, Chronic , Kidney , Nephritis, Hereditary , Nephrotic Syndrome , Protein Deficiency , Renal Insufficiency, Chronic , Wilms TumorABSTRACT
La glomerulonefritis rápidamente progresiva (GNRP) es una entidad caracterizada por una brusca y progresiva declinación de la función renal y por la presencia en la biopsia renal de proliferación celular extra capilar (semilunas) que ocupan el espacio de Bowmans. Nosotros analizamos en forma retrospectiva 37 niños con diagnóstico de GNRP (50% o más de los glomérulos con semilunas) asistidos en esta institución durante los últimos 20 años. El propósito fue evaluar la presentación clínica e histopatológica, etiología, evolución y factores de mal pronóstico. La edad media al diagnóstico fue de 11 ± 3,5 años. Los síntomas de presentación fueron: hematuria 100% de los casos (hematuria macroscópica 56%); hipertensión arterial 92%; proteinuria 88%; síndrome nefrótico 57%. Fue necesaria diálisis al ingreso en el 64,1% de los casos. Las biopsias renales fueron realizadas a 38 ± 26 días desde el comienzo de los síntomas. El porcentaje de glomérulos que presentaron semilunas fue del 81,4%; las mismas fueron epiteliales en el 28,3% de los casos; fibroepiteliales en el 21,8% y fibrosas en el 31,3%. En el 75,8% de las biopsias se encontró fibrosis intersticial y atrofia tubular moderada y/o severa. La inmunofluorescencia no mostro depósitos de complejos inmunes (GN pauci-inmune) en el 40,6% de las biopsias, mostró depósitos granulares de complejos inmunes en el 48,6% y depósitos lineales de anticuerpos anti membrana basal glomerular (Goodpasture´s) en el 10,8%. El tratamiento fue iniciado a 36 ± 32 días desde el comienzo de los síntomas. Todos los pacientes recibieron tratamiento de sostén; en 29 de ellos se indicaron además esteroides y ciclofosfamida, y en 5 solo esteroides. El tiempo medio de seguimiento fue de 4,6 ± 3,9 años. La sobrevida de los pacientes al final del seguimiento fue del 87% (IC95% 55-97%) y la sobrevida del órgano fue del 17% (IC95% 7-38%). Por análisis multivariado encontramos que la fibrosis intersticial y atrofia tubular moderada y/o severa fue el único factor que se relacionó con pérdida del órgano (OR: 14,6 IC95%2,6-80) p= 0,001. Nuestros resultados muestran que la GNRP en niños es una entidad con pobre pronóstico en relación a la función renal. El factor de peor pronóstico que puede llevar a la pérdida del órgano es el compromiso túbulo-intersticial (AU)
Rapidly progressive glomerulonephritis (RPGN) is characterized by a sudden and progressive decrease of kidney function and extra-capillary cell proliferation (crescents) occupying the Bowman's space on the biopsy. We retrospectively analysed 37 children with RPGN (50% or more of glomeruli with crescents) seen at our institution over the past 20 years. The purpose of the study was to evaluate clinical and histopathological presentation, etiology, outcome, and factors of poor prognosis. Mean age at diagnosis was 11 ± 3.5 years. Presenting symptoms were: hematuria in 100% of the cases (macroscopic hematuria 56%); arterial hypertension in 92%; proteinuria in 88%; and nephrotic syndrome in 57%. Dialysis was necessary on admission in 64.1% of the cases. Kidney biopsies were performed at 38 ± 26 days after symptom onset. The percentage of glomeruli that presented crescents was 81.4%; they were epithelial in 28.3% of the cases, fibroepithelial in 21.8%, and fibrous in 31.3%. In 75.8% of the biopsies interstitial fibrosis and moderate and/or severe tubular atrophy was found. Immunofluorescence techniques did not show immune complex deposits (pauci-immune GN) in 40.6% of the biopsies. Granular deposits of immune complexes were found in 48.6% and linear anti-glomerular basement membrane deposits (Goodpasture´s) in 10.8%. Treatment was started 36 ± 32 days after symptom onset. All patients received support treatment; in 29 steroids and cyclophosphamide were also indicated, and in 5 steroids only. Mean time of follow-up was 4.6 ± 3.9 years. Patient survival at the end of follow-up was 87% (95%CI 55-97%) and organ survival was 17% (95%CI 7-38%). On multivariate analysis we found that interstitial fibrosis and moderate and/or severe tubular atrophy was the only factor related to organ loss (OR: 14.6; 95%CI 2.6-80) p= 0.001). Our results show that RPGN in children has a poor prognosis regarding kidney function. Tubulo-interstitial involvement is the factor of poor prognosis that may lead to organ loss (AU)
Subject(s)
Humans , Infant , Child, Preschool , Cell Proliferation , Disease Progression , Glomerulonephritis/drug therapy , Glomerulonephritis/etiology , Glomerulonephritis/pathology , Prognosis , Cohort Studies , Retrospective StudiesABSTRACT
Hemolytic anemia and thrombocytopenia are rare clinical manifestations of acute glomerulonephritis. Initially, in all such cases, a diagnosis of hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, systemic lupus erythematosus, and amyloidosis should be ruled out. The presence of hemolytic anemia and thrombocytopenia is rare, but possible, in a case of acute poststreptococcal glomerulonephritis, and may result in delayed diagnosis or misdiagnosis. Correct and timely diagnosis would ensure adequate treatment in such patients. We report of a 22-month-old boy with acute glomerulonephritis coexistent with hemolytic anemia and idiopathic thrombocytopenia.
Subject(s)
Humans , Infant , Male , Amyloidosis , Anemia, Hemolytic , Delayed Diagnosis , Diagnosis , Diagnostic Errors , Glomerulonephritis , Hemolytic-Uremic Syndrome , Lupus Erythematosus, Systemic , Purpura, Thrombotic Thrombocytopenic , ThrombocytopeniaABSTRACT
Hemolytic anemia and thrombocytopenia are rare clinical manifestations of acute glomerulonephritis. Initially, in all such cases, a diagnosis of hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, systemic lupus erythematosus, and amyloidosis should be ruled out. The presence of hemolytic anemia and thrombocytopenia is rare, but possible, in a case of acute poststreptococcal glomerulonephritis, and may result in delayed diagnosis or misdiagnosis. Correct and timely diagnosis would ensure adequate treatment in such patients. We report of a 22-month-old boy with acute glomerulonephritis coexistent with hemolytic anemia and idiopathic thrombocytopenia.
Subject(s)
Humans , Infant , Male , Amyloidosis , Anemia, Hemolytic , Delayed Diagnosis , Diagnosis , Diagnostic Errors , Glomerulonephritis , Hemolytic-Uremic Syndrome , Lupus Erythematosus, Systemic , Purpura, Thrombotic Thrombocytopenic , ThrombocytopeniaABSTRACT
Refere-se a um caso atendido com quadro clínico e laboratorial sugestivos de glomerulonefrite aguda pós-estreptocócica (GNPE) apresentando proteinúria em níveis nefróticos. Como em apenas 5% dos casos de GNPE há proteinúria em níveis nefróticos, foi necessário excluir outras doenças renais através da realização de biópsia renal com estudo por microscopia óptica, eletrônica e imunofluorescência, que confirmaram a suspeita clínica de GNPE
Subject(s)
Humans , Male , Adolescent , Glomerulonephritis/diagnosis , Glomerulonephritis/therapy , Proteinuria/complications , Streptococcal InfectionsABSTRACT
Form March 1982 to December 1991, 110 cases of typical post-streptococcal glomerulonephritis and 25 cases of Atypical acute glomerulonephritis were clinically investigated at Department of pediatrics, Kyung Hee University Hospital, and following Data were obtained. 1) Male to Femal ratio was 1.8:1 (Atypical AGN). peak incidence was from 7 to 12 years. 2) The most common preceding infections were upper respiratory infection, unknown, cervical lymphadenitis, scarlet fever, Incubation periods were mostly from 1 to 2 weeks. 3) The most common chief complaints were edema, gross hematuria, oliguria, headache. 4) The most common physical findings were facial edema, hypertension, pharyngeal injection. 5) There were significant difference between atypical AGN and typical PSGN in the BUN and WBC (P<0.05, p<0.1). Also there were significant difference between typical PSGN and atypical AGN in the ESR (P<0.1). 6) Treatment regimens were penicilline, dipyridamole, anti-hypertensive agents. 7) Complete recovery occurs in most of most of patients within 1 year.
Subject(s)
Humans , Male , Antihypertensive Agents , Dipyridamole , Edema , Glomerulonephritis , Headache , Hematuria , Hypertension , Incidence , Lymphadenitis , Oliguria , Pediatrics , Penicillins , Scarlet FeverABSTRACT
A clinical study was done on 199 cases of Acute Glomerulonehritis, who had been admitted to the department of Pediatrics, Chonnam National University Hospital during the five years period from January 1976 to December 1980. The following results were obtained. 1) Males were affected more frequently than females by a 2:1 ratio, and the highest incidence was noted in children between 4 and 6 years of age, with a seasonal peak in Autumn and Winter. 2) The 57.8% of the total patients had history of preceding infections. The upper respiratory tract infection was most common, which was 51.3% of the total patients, and the skin infection was identified in 4.0% of the total patients. 3) The most common chief complaint was edema. Blood pressure of greater than 90mmHg in diastolic pressure was noted in approximately half of the patients. 4) Chest X-ray revealed cardiomegaly in21.9%, pulmonary edema in 12.8%, and pleural effusion in 9.1%. 5) The percentage of positive beta-hemolytic streptococcal culture was 12.3%, and Anti-Streptolysin O titer of greater than 333 Todd units was noted in 64.5%. 6) The mean value of serum C3 concentrationin the Acute Glomerulonephritis Group as a whole was lower than that of the Control Group and the difference was statistically significant(p<.001). 7) Gross hematuria and edema disappeared in most of the patients within 2 weeks after the onset of the symptoms, and the elevated blood pressure returned to normal within 2 weeks after admission. 8) Microscopic hematuria and proteinuria disappeared in most of the patients within 3 months after admission.
Subject(s)
Child , Female , Humans , Male , Blood Pressure , Cardiomegaly , Edema , Glomerulonephritis , Hematuria , Incidence , Pediatrics , Pleural Effusion , Proteinuria , Pulmonary Edema , Respiratory Tract Infections , Seasons , Skin , ThoraxABSTRACT
Serum cholinesterase and other commonly employed function tests were determined in 12 patients with nephrotic syndrome, 17 patients with infectious hepatitis and 7 patients with acute glomerulonephritis who were available for se5rial studies the evaluation of which was helpful in diagnosis, management and prognosis of various disease. The results were as follows. 1) Serum cholinesterase activity in patients with nephrotic syndrome was much higher than normal. Thereafter the activity progressively turned into the normal. Value associated with improvement of the values of other function tests and clinical courses in case which responded positively to treatment. 2) In patients with infectious hepatitis serum cholinesterase was lower than the normal value but the steadily rose from low to normal value according to improvement of clinical courses. In two patients with postnecrotic cirrhosis and toxic hepatitis the activity was much lower than normal but other function tests showed normal range. 3) Serum cholinesterase in patients with glomerulonephritis showed atypical charges during clinical courses.
Subject(s)
Humans , Cholinesterases , Diagnosis , Chemical and Drug Induced Liver Injury , Fibrosis , Glomerulonephritis , Hepatitis A , Nephrotic Syndrome , Prognosis , Reference ValuesABSTRACT
The activity of interleukin-2 (IL-2) and expression of interleukin-2 receptor (IL-2 R) were measured in children with acute glomerulonephritis (AGN) in order to detemine the mechanism of the disease Our results showed that the activity of IL-2 in peripheral blood lymphocytes (PBL) of children with AGN was lower than that tof the control group (P