Physician: Glomerulonephritis

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I have a video and medical on a 10 year old little girl from Russia. 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 infection.

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 cutaneous 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 initial presentation.

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 extremely rare.

by James Reilly, M.D.

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