ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS in children : summarized

ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS

                                            

                                                Dr Anum Arif

ACUTE NEPHRITIC SYNDROME CHARACTERISED by

1.       Gross hematuria

2.       Edema

3.       Hypertension

4.       Renal insufficiency

CAUSATIVE AGENT:

 Group-A Beta hemolytic streptococci

APSGN is caused by streptococcal pharyngitis during the cold weather and streptococcal pyoderma or skin infection during warm weather

There will be mesangial cell proliferation and polymorphonuclear lymphocytes infiltration in mesangium during early stages and Ig and complement deposits in GBM in severe cases.

Streptococcal antigen share molecular mimicry with glomerular antigen and elicit antistreptococcal antibodies against them to form immune complexes. Streptococcal pyogenic exotoxin (SPE) B and nephritis associated streptococcal plasmin are particularly involved.

CLINICAL FEATURES:

Children of age group 5-12 yr give a preceding history of 1-2 week pharyngitis and 3-6 week history of skin infection.

·         Patients can be asymptomatic with microscopic hematuria

·         Or can present  with gross hematuria and decreased urine output

·         Edema, respiratory distress(due to fluid overload)

·         There can be complications of hypertension like encephalopathy and heart failure and even Fits

Examination may yield Altered sensorium , edema, pallor, tachypnea, tachycardia, Hypertension, raised JVP, hepatomegaly , basal pulmonary crepitation ,gallop rhythm, impetigo .

DIAGNOSIS

URINE COMPLETE EXAMINATION: RBCs, rbc casts, proteinuria.

CBC:  anemia due to hemodilution and hemolysis

COMPLEMENT LEVELS:   

·         C3 is markedly low and return to normal after 6-8 week.

·         C4 is usually normal

ANTIBODY LEVEL:

·         Antistreptolysin O and anti-Dnase B antibody will be markedly raised to confirm previous streptococcal infection.

·         Throat culture +ve for only 15% cases.

Renal Ultrasound Scan: to assess size and texture of parenchyma

CHEST XRAY:  in case of heart failure

RENAL BIOSY ; is indicated if C3 levels do not normalize after 8 weeks, or if there is nephrotic range proteinuria , or if there is renal parenchymal disease noted on renal scan. *consult Seniors

TREATMENT:

Admit the patient.
It is a self limited disease , Supportive therapy is indicated.

Assess Airway, Breathing , Circulation.
Monitor GCS, P.R , R.R , BP, CRT, SpO2, Urine Output.
Treat Hypertension , Fits, and Fluid Over load (with/without cardiac failure).
Treat Acute kidney injury (may need fluid restriction)
Patient may need blood transfusion.

COMPLICATIONS:

·         Hypertension with hypertensive encephalopathy

·         Heart failure

·         Hyperkalemia

·         Hyperphosphatemia

·         Hypocalcemia

·         Acidosis

·         Seizures

·         Uremia