Clinico-Etiologic Profile of Macroscopic Hematuria in Children: A Single Center Experience

Objective: To study the demographic, clinical and etiological profile of macroscopic hematuria in children presenting to a tertiary care hospital. Methods: This prospective observational study, conducted between January, 2018 and December, 2019, enrolled children aged 3 months to 12 years, presenting with gross hematuria. Results: Of the 62 children (44 males) enrolled, (mean (SD) age of 7.3 (2.6) years), glomerular hematuria was seen in 59.7%. Post-infectious glomerulonephritis was the commonest etiology of glomerular hematuria; hypercalciuria and renal calculi predominated among non-glomerular hematuria. After a median (IQR) follow up of 8 (6,14.2) months, microscopic hematuria persisted in 10 (7, glomerular hematuria) children. The median time to resolution of gross as well as microscopic hematuria tended to be longer in glomerular etiologies. Conclusion: Majority of children with gross hematuria had glomerular etiologies, thus requiring monitoring and follow-up.

Simultaneous presentation of post infectious glomerulonephritis and acute rheumatic fever in an eight year old girl child

An 8-year-old female child presented with simultaneous symptoms of post infectious glomerulonephritis and acute rheumatic fever. The child was treated with penicillin V, Aspirin and she responded well to the treatment. However, this co presentation of acute rheumatic fever and post infectious glomerulonephritis in a child is rare and hence authors report the case. This sequela of streptococcal autoimmunity are considered to be pathogenetically distinct.

The Incident of Acute Post-infectious Glomerulonephritis (PIGN) in Pediatric Age Group at King Fahad University Hospital in Eastern Province of Saudi Arabia

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.

Acute renal failure by rapidly progressive glomerulonephritis with IgA deposition in a patient concomitantly diagnosed with multibacillary Hansen's disease: a case report / IRA por glomerulonefrite rapidamente progressiva com depósito de IgA em uma paciente com diagnóstico concomitante de hanseníase multibacilar: relato de caso

ABSTRACT Rapidly progressive glomerulonephritis (RPGN) is a renal disease with an extensive differential diagnosis. This paper reports the case of a 55-year-old female patient diagnosed with Hansen's disease with acute progressive renal impairment after developing lower limb pyoderma. The association between Hansen's and kidney disease has been well documented, with glomerulonephritis (GN) ranked as the most common form of renal involvement. Post-infectious glomerulonephritis (PIGN) in adults has been associated with a number of pathogens occurring in diverse sites. The patient described in this case report had RPGN and biopsy findings suggestive of PIGN with C3 and IgA detected on immunofluorescence and kidney injury secondary to recent infection by Staphylococcus, a well-documented manifestation of renal impairment in patients with Hansen's disease.

RESUMO A Glomerulonefrite Rapidamente Progressiva (GNRP) é um padrão de doença renal com amplo diagnóstico diferencial. O caso reporta uma paciente de 55 anos com deterioração aguda e progressiva da função renal após quadro de piodermite em membro inferior com diagnóstico concomitante de hanseníase. Associação da hanseníase com doença renal é bem descrita, sendo a GN a forma de acometimento renal mais comum. As glomerulonefrites pós-infecciosas (GNPIs) em adultos ocorrem devido a um grande número de patógenos, nos mais diversos sítios. A paciente do caso relatado apresentava quadro de GNRP e achados de biópsia que sugerem GNPI com marcação de C3 e IgA na imunofluorescência, sugestiva de lesão renal secundária a infecção recente por Staphylococcus, uma manifestação bem descrita de doença renal em pacientes com hanseníase.

Glomerulonefritis por inmunocomplejos en la endocarditis infecciosa / Immune complex glomerulonephritis in infective endocarditis

Los pacientes con endocarditis infecciosa pueden desarrollar tres diferentes formas de enfermedad renal: Glomerulonefritis postinfecciosa mediada por complejos inmunes, nefritis intersticial aguda inducida por drogas o necrosis tubular aguda por aminoglucósidos y la enfermedad embólica renal. La glomerulonefritis mediada por inmunocomplejos es similar a la glomerulonefritis post Estreptocócica o la glomerulonefritis membranoproliferativa con antigenemia larga y persistente. Las manifestaciones clínicas son similares a las de aquellos pacientes con otras formas de glomerulonefritis aguda. Presentamos el caso de una paciente que cumplió los requisitos para entrar dentro el grupo de glomerulonefritis por complejos inmunes, destacando el hecho de presentar alteraciones en la función renal y sedimento urinario disipadas con la resolución de la patología de base.

Patients with infective endocarditis can develop three different forms of renal disease: post infectious immune complex mediated glomerulonephritis, drug induced acute intersticial nephritis or acute tubular necrosis due to aminoglucoside toxicity and renal embolic disease. Inmune complex glomerulonephritis is similar to post estreptococal glomerulonephritis or membrano proliferative glomerulonephritis with long standing and persistent antigenemia. The clinical manifestations are similar to those of other forms of glomerulonephritis. We present the case of a patient who fulfilled most criteria of immune complex mediated glomerulonephritis. emphasizing the fact that the alterations in renal function and urinary sediment resolved with the resolution of the primary disease.

Proliferative gknerulonephritis: the profiles of proliferation and apoptosis / 中华肾脏病杂志

Objective Hypercellularity in proliferan've glomerulonephritis can result from either increased proliferation or the failure of cells to undergo apoptosis in response to stimuli. Increasing evidence supports that alterations in the control of cell survival are important in the pathogenesis of proliferative glomerulonephritis. Methods Apoptotic cells in the glomeruli have been analyzed by the in situ end labeling (ISEL) of TdT from patients diagnosed with membranoproliferative glomerulonephritis (MPGN, n = 12), type IV lupus nephritis (LN, n = 15) and acute postinfectious glomerulonephritis (APGN, n = 13) in the present study. In addition, the proliferating cell nuclear antigen (PCNA)-positive proliferating glomerular cells were observed by immunochemical 4 layer PAP method in these patients. Results The ratio of proliferating and apoptotic cells was the highest one in patients with MPGN (3.91) as compared to APGN (1.28) and LN(1 .02). The extends of increasing apoptotic cells in the glomeruli were different among patients with MPGN,, APGN and LN, although all of them showed extremely glomerular hypercellularity. The number of apoptotic glomemlar cells was significantly higher in patients with APGN (1.16?0.35) than those with MPGN (0.12?0.16) as well as LN patients (0.35 ? 0.20). Conclusion Apoptosis is essential in the resolution of glomerular cellularity together with the remodeling processes. Intense proliferations without increment in apoptosis are the characterisitics of MPGN and LN associated with their renal histological changes and prognosis.