Post Streptococcal Glomerulonephritis

Posted by e-Medical PPT Wednesday, December 15, 2010
Post streptococcal glomerulonephritis is a common disease in children and  characterized by the abrupt onset of hematuria and proteinuria, often accompanied by azotemia (ie, decreased glomerular filtration rate) and renal salt and water retention.  Acute Post Streptococcal Glomerulonephritis in children which occurs after a streptococcal throat infection (sore throat with exudates or pus,congested throat, enlarged lymph nodes in the neck and may be a membrane on the tonsills).

Characteristic features of post streptococcal glomerulonephritis
    * History of strptococcal throat infection within the past 5 days to weeks
    * No history of previous renal disease.
    * No family history of renal diseases.
    * Red urine described as smoky coca-cola like colour (hematuria). This is also associated with oliguria (reduced amount of urine)
    * Hypertension occurs in 70% of cases and it rises all of a sudden and may also suddenly drop back to normal and so on. Hypertension needs early managment and proper treatment and it's the cause of most the complications associated with the disease.
    * Edema. It starts in the eyes as puffy eye lids in the morning (puffy eyes) and it may progress to edema of the limbs but most of the time edema is not marked.
    * Complications include hypertensive encephalopathy, heart failure and elecvtrolyte disturbances.

95% of the cases recover completely and the disease never recurs in the same child. Only a little proportion of the cases develope renal failure or chronicity.
Treatment of Acute Glomerulonephritis in children :
    * Hospital admission to monitor blood pressure changes.
    * Salt and fluid restriction if needed (in marked edema, oliguria and H.F.)
    * Antibiotic therapy to eradicate infection (long acting Penicillin, one dose intramuscular, dose is calculated according to the age).
    * Treatment of hypertension using diuretics, ACE inhibitors and calcium channel blockers. Other complications such as renal failure, heart failure and electrolytes disturbances should be treated immediately.

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