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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Post-streptococcal glomerulonephritis (PSGN) classically presents with hypertension, edema, macroscopic hematuria, acute renal failure, proteinuria, and an active urine sediment with red blood cells and red blood cell casts. A patient who developed PSGN but who had only minimal and transient abnormalities in the urinalysis is reported. Physicians should be aware that a normal urinalysis does not rule out the diagnosis of PSGN.
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PMID:Post-streptococcal glomerulonephritis with minimal abnormalities in the urinary sediment. 130 69

A total of 395 consecutive patients with biopsy-proven glomerulonephritis were followed up for 14 years. At the time of entry to the study the patients were classified as having one of nine states of kidney disease according to serum creatinine levels and proteinuria. The transitions of the patients between the nine states were analysed. The influence of 14 independent variables including treatment with cytostatic drugs and prednisolone was estimated by the Cox proportional hazard model. Treatment with immunosuppressive drugs had an influence that emerged within the first month and continued for the next 2 months. Subsequent treatment with cytostatic drugs in combination with prednisolone delayed further improvement. Treatment with prednisolone or cytostatic drugs as single therapy for up to 6 months increased the risk of improvement of the disease, and had no significant effect on deterioration. The beneficial effect of the treatment persisted after withdrawal of the immunosuppressive drugs. The analysis revealed only a slight influence of the histological character of the glomerular changes. Post-streptococcal glomerulonephritis carried an increased tendency for improvement. Arterial hypertension affected the process in several states of kidney disease. Heavy proteinuria increased the risk of increasing serum creatinine levels.
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PMID:Prognosis in glomerulonephritis. III. A longitudinal analysis of changes in serum creatinine and proteinuria during the course of disease: effect of immunosuppressive treatment. Report from Copenhagen Study Group of Renal Diseases. 158 57

Acute glomerulonephritis is characterized by the presence of hematuria, proteinuria and edema, and often hypertension and acute renal failure. Acute post-streptococcal glomerulonephritis is the prototypic disease of acute glomerulonephritis. It is seen after both streptococcal pharyngeal and skin infections with a latency period from infection to presentation of 7-14 days and 14-21 days respectively. Approximately 90 percent of post-streptococcal glomerulonephritis occurs in young children. The diagnosis is made by supporting evidence of recent streptococcal infection, a positive ASO-titer or Anti-DNAase B titer, with associated hypocomplementemia. The disease is self-limited and generally requires only supportive therapy with resolution occurring over a period of weeks to months. There are generally no permanent sequelae in children. Adults may have a higher incidence of hypertension and chronic renal failure as a result of post-streptococcal glomerulonephritis.
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PMID:Acute post-streptococcal glomerulonephritis. 200 61

Eight hundred and sixty four children were admitted with Acute post-streptococcal glomerulonephritis (APSGN) at the Institute for Child Health, Madras, during the period January 1981 to January 1983. Majority of the cases followed infected scabies or impetigo. 135 children were investigated and followed up for a period of 1-2 years. The disease had an excellent prognosis in these children. None of those examined 2 years after discharge had proteinuria or hypertension. Group A beta hemolytic streptococcus (BHS) was isolated in 13.4% of patients and 11.25% of skin infection controls. Eight different T types were identified in patients and 6 T types in pyoderma cases. All patients and 87% of skin infection controls had elevated anti-D Nase B titres, while ASO titres were not significantly raised.
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PMID:Post-streptococcal acute glomerulonephritis: a clinical, bacteriological and serological study. 213 8

The differential diagnosis of hematuria with or without proteinuria is extensive, and isolated hematuria is a common problem in children and adolescents. Extensive evaluation is often necessary for the child presenting with macroscopic plus microscopic hematuria including nonglomerular and glomerular etiologies, while children with only isolated microscopic hematuria can generally be followed after baseline evaluation to rule out infection, hypercalciuria, familial hematuria, sickle cell disease, post-streptococcal glomerulonephritis (GN), and structural abnormalities (cysts, stones, obstruction, Wilms tumor). Children with the combination of hematuria and proteinuria require rapid systematic evaluation, generally including renal biopsy, except in cases where post-streptococcal GN can be clearly documented. Post-streptococcal GN occurs 7-21 days after a streptococcal infection, is associated with an acute fall in C3 levels with return to normal by approximately 8 weeks, rarely causes acute renal failure, and in children has a pattern of gradual resolution of hypertension, hematuria, and proteinuria over a course of 6-12 months.
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PMID:Asymptomatic hematuria in childhood: a practical approach to evaluation. 1079 63

Acute poststreptococcal glomerulonephritis(PSGN) is characterized by an abrupt onset of edema,hypertension, and hematuria. Although the association of pulmonary edema with acute glomerulonephritis has been established, it is uncommon for children with PSGN to present with respiratory distress due to pulmonary edema. We encountered six such patients, aged 6-10 years, during a 10-month period. The demographic data, clinical manifestations, laboratory data, radiographic pictures, and clinical courses were collected. All patients presented to the primary pediatricians with dyspnea and alveolar infiltrates with bilateral pleural effusions on plain chest radiographs that were misinterpreted as pneumonia initially. The diagnosis of PSGN was de-layed until the awareness of the presence of pulmonary edema complicating PSGN. Subsequent urinalysis and blood pressure measurement all showed microscopic hematuria and hypertension. Elevated serum antistreptolysin 0 titers and depressed serum complement C3 levels confirmed the diagnosis of PSGN. Two patients progressed to respiratory failure because of a delayed diagnosis of PSGN. All patients recovered without sequelae following appropriate diuresis and antihypertensive therapy. We conclude that in preschool and school-age children who present with dyspneic respirations and a chest radiograph showing radiographic features of pulmonary edema, proper evaluation including blood pressure recording and urinalysis should be performed immediately. Prompt diagnosis and early therapy of PSGNmay avoid mortality and unnecessary therapeutic intervention.
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PMID:Poststreptococcal glomerulonephritis with pulmonary edema presenting as respiratory distress. 1694 12

Post-infectious glomerulonephritis is one of the most common causes of acute glomerulonephritis. A retrospective study of post-infectious glomerulonephritis at King Chulalongkorn Memorial Hospital, Thailand was performed from January 1999 to December 2005. Among thirty six patients, eight cases were post-streptococcal glomerulonephritis and twenty eight cases were post non-streptococcal Glomerulo Nephritis (GN). Most cases present with edema, hypertension, gross hematuria and nephrotic-range proteinuria. C3 and CH50 commonly were low. Post-streptococcal glomerulonephritis had more aggressive pathology compared to the others. However the long term outcome was excellent. In the present study the authors found ESRD in only 14.3% (4 out of 28 cases) that reflects the excellent prognosis of post-infectious glomerulonephritis. Of interest, all of the ESRD patients were caused by post non-Streptococcal GN. Even though, no statistic was achieved; it might reflect the aggressiveness of non-Streptococcal pathogen.
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PMID:The clinicopathology and outcome of post-infectious glomerulonephritis: experience in 36 adults. 1704 68

Acute post-streptococcal glomerulonephritis (PSGN) is characterized by an abrupt onset of edema, hypertension, and hematuria. Life-threatening diffuse alveolar hemorrhage (DAH) is rarely associated with acute PSGN. There have been only two reported cases worldwide, and no case has been reported previously in Korea. Here, we present a patient who clinically presented with pulmonary-renal syndrome; the renal histology revealed post-infectious glomerulonephritis of immune complex origin. A 59-yr-old woman was admitted with oliguria and hemoptysis two weeks after pharyngitis. Renal insufficiency rapidly progressed, and respiratory distress developed. Chest radiography showed acute progressive bilateral pulmonary infiltrates. The clinical presentation suggested DAH with PSGN. Three days after treatment with high-dose steroids, the respiratory distress and pulmonary infiltrates resolved. Electron microscopy of a renal biopsy specimen sample revealed diffuse proliferative glomerulonephritis with characteristic subendothelial deposits of immune complex (''hump''). The renal function of the patient was restored, and the serum creatinine level was normalized after treatment.
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PMID:A case of post-streptococcal glomerulonephritis with diffuse alveolar hemorrhage. 1843 27

Acute poststreptococcal glomerulonephritis (APSGN) is the most common prototype of acute glomerulonephritis in children, and is characterized by the sudden onset of gross hematuria, edema, hypertension and volume overload. Brain natriuretic peptide (BNP) is produced in both the brain and the heart. Its prohormone, proBNP, is cleaved to biologically active BNP and an inactive N-terminal peptide of proBNP (NT-proBNP). NT-proBNP is released predominantly from the ventricles in response to hypervolemia and pressure overload. We therefore investigated the relationship between NT-proBNP levels and cardiac functions of patients with APSGN. NT-proBNP levels were measured in 28 patients with APSGN (17 boys and 11 girls of 8.2 +/- 2.9 years old) and in 26 healthy children (control group). Echocardiograms were performed in both patient and control groups on admission, and only in the patient group two weeks later. Upon admission, the plasma NT-proBNP levels were higher in the patients than in the control group (8876.2 +/- 9650.8 vs 69.5 +/- 22.2 pg/mL, p < 0.001), and left ventricular dysfunction was detected in six patients. Moreover, NT-proBNP levels were significantly higher in the patients with left ventricular dysfunction than other patients (n = 22). There was no significant difference in the levels of NT-proBNP between the patient and control groups, after diuretic treatment of the patients. Plasma NT-proBNP levels were positively correlated with the severity of APSGN. Thus, NT-proBNP level may be a useful marker to assess the volume overload and cardiac function in the follow up of selected APSGN patients.
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PMID:Elevated plasma levels of N-terminal pro-brain natriuretic peptide in children with acute poststreptococcal glomerulonephritis. 1934 34

The aim of this study was to define the current demographic, clinical and prognostic characteristics of acute post-streptococcal glomerulonephritis (APSGN) in French Polynesia and to compare these features with those of other populations. Fifty children, all of whom were <15 years old and had been admitted to the Territorial Hospital of Papeete for APSGN between January 2005 and December 2007, were retrospectively enrolled in the study. Diagnostic criteria were microscopic or macroscopic haematuria, decreased C3 fraction of the complement and evidence of recent streptococcal infection. The annual incidence was 18 cases per 100,000 children <15 years of age in 2007. Most of the children (98%) enrolled in the study were of Polynesian ethnic origin, 27 were male (54%), and the average age at presentation was 6.7 years. Signs of previous respiratory infections were clearly evident in 40% of the children. Most of the patients presented during the rainy season, correlating with the relatively high incidence of skin infections at this time. The majority of patients had proteinuria (98%), with 25% having proteinuria in the nephrotic range (proteinuria/urinary creatinine >3 g/g). The presentation was severe in 22% of the children (congestive cardiac failure, severe hypertension and/or encephalopathy), and renal failure was an initial presenting symptom in 43.7%. The C3 fraction was lower in severe presentations, but the type of haematuria, level of proteinuria and inflammatory syndrome were not correlated with immediate severe forms or with initial renal failure. Haematuria resolved in a mean of 7.7 months and proteinuria in a mean of 3.9 months. None of the children had hypocomplementemia for more than 8 weeks. Acute post-streptococcal glomerulonephritis is endemic among French Polynesians, and they can be considered to be a high-risk population. Despite a high incidence of skin infections, however, the predominance of respiratory infections potentially indicates that French Polynesia is on the way to become a low-incidence area. Systematic detection and treatment of group A Streptococcus should be intensified.
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PMID:Acute post-streptococcal glomerulonephritis in children of French Polynesia: a 3-year retrospective study. 1987 55


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