I have a video and medical on a 10 year old little girl from
She appears very normal and healthy. Her medical history says she has had
streptodermia and acute glomerulonephritis (hematuria type). Chronic
glomerulonephritis in remission. What is this medical problem?
Glomerulonephritis is both a generic term for several
diseases and a histopathologic term signifying inflammation of the glomerular
capillaries in the kidney. Outbreaks are known where "nephritis"
strains of group A strep germs are circulating in the blood stream, it is
usually is sporadic.
Since there are many different forms of glomerulonephritis
there are many different ways it can present. Post streptococcal glomerulonephritis
usually presents after an illness with the strep germ either through strep
throat or classically from a skin infection such as impetigo. It is most common
in children aged 5-12 yr and uncommon before the age of 3 yr. The typical
patient develops an acute nephritic syndrome 1-2 wk after an antecedent
streptococcal pharyngitis or 3-6 wk after a streptococcal pyoderma, or skin
The patient usually can present with coca cola colored urine
or it can be found incidentally on examination of the urine. There can be
increases in blood pressure if the kidneys are significantly damaged along with
edema (swelling of the extremities).
Urinalysis demonstrates red blood cells, RBC casts,
proteinuria, and polymorphonuclear leukocytes. Anemia may be present from
low-grade hemolysis and retention of fluid. The serum C3 level is usually
decreased in the acute phase and returns to normal 6-8 wk after onset.
A positive throat culture report may support the diagnosis
or may simply represent the carrier state. The best single antibody titer to
document coetaneous streptococcal infection is the deoxyribonuclease (DNase) B
antigen. An ASLO may be done but it notoriously does not rise after skin
infections with strep.
The diagnosis of poststreptococcal glomerulonephritis is
quite likely in a child presenting with acute nephritic picture, evidence of
recent streptococcal infection, and a low C3 level. It is important to consider
other diagnoses however.
Treatment of the infection which caused the post
streptococcal glomerulonephritis is done first, and then treatment is
supportive. Management is directed at treating the acute effects of renal
insufficiency and hypertension .A 10-day course of systemic antibiotic therapy
with penicillin is recommended. However it does not affect the natural history
of glomerulonephritis. The acute phase generally resolves within 6-8 wk.
Although urinary protein excretion and hypertension usually normalize by 4-6 wk
after onset, persistent microscopic hematuria may persist for 1-2 yr after the
Complete recovery occurs in more than 95% of children with
acute poststreptococcal glomerulonephritis.
Mortality in the acute stage can be avoided by appropriate
management of acute renal failure, cardiac failure, and hypertension.
Infrequently, the acute phase may be severe. However, the
diagnosis of acute poststreptococcal glomerulonephritis must be questioned in
patients with chronic renal dysfunction because other diagnoses such as
membranoproliferative glomerulonephritis may be present. Recurrences are
By James Reilly M.D. of www.adoptiondoctor.com
* Note: The information and advice provided is intended to
be general information, NOT as advice on how to deal with a particular child's
situation and or problem. If your child has a specific problem you need to ask
your pediatrician about it -- only after a careful history and physical exam
can a medical diagnosis and/or treatment plan be made.
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