Glomerulonephritis Case Studies: A 7-Year-Old Boy Was Brough

Glomerulonephritis Case Studies A 7-year-old boy was brought to his pediatrician because he had

A 7-year-old boy presented with signs of acute glomerulonephritis, characterized by hematuria, proteinuria, hypertension, and impaired renal function. His history included a recent streptococcal pharyngitis, mild lethargy, decreased appetite, fever, back pain, and hematuria. Laboratory and imaging studies revealed significant renal impairment, with elevated blood urea nitrogen (BUN) and serum creatinine, enlarged kidneys on ultrasound, and biopsy findings consistent with glomerulonephritis. The case illustrates the clinical progression of poststreptococcal glomerulonephritis and its management.

Paper For Above instruction

Glomerulonephritis, specifically poststreptococcal glomerulonephritis (PSGN), represents an inflammatory process affecting the glomeruli within the kidneys, primarily triggered by an immune response to preceding streptococcal infections such as pharyngitis or skin infections (Choi et al., 2018). This condition predominantly affects children between 5 to 15 years old, often presenting with hematuria, edema, hypertension, and renal dysfunction, as demonstrated in the case of the 7-year-old boy.

Pathophysiology and Clinical Presentation

The pathogenesis of PSGN involves immune complex deposition in the glomeruli following streptococcal infections. These immune complexes activate complement pathways, leading to inflammation, glomerular swelling, and damage (Roth et al., 2019). Typically, the onset occurs one to three weeks post-infection, coinciding with the boy's history of recent sore throat and elevated anti-DNase B titers. The clinical features include hematuria producing a characteristic "tea-colored" or red-tinged urine, proteinuria, hypertension, and edema (Niaudet, 2020). The boy's initial presentation of hematuria, hypertension (BP 140/100 mm Hg), and decreased renal function aligns with the classic PSGN presentation.

Diagnostic Evaluation

Diagnosis involves a combination of clinical assessment, laboratory studies, and imaging. The urinalysis showing hematuria with red blood cell casts and proteinuria indicates glomerular damage (Kumar & Abbas, 2021). Elevated BUN and creatinine levels reflect renal impairment, while ultrasound imaging of enlarged, edematous kidneys supports an inflammatory process. The positive immunoglobulin G (IgG) staining and reduced complement levels (particularly C3) further confirm immune complex-mediated glomerulonephritis (Niaudet, 2020). The elevated anti-DNase B titer indicates recent streptococcal infection. The biopsy findings of glomerular swelling with leukocyte infiltration corroborate the diagnosis.

Management and Prognosis

The primary treatment focuses on managing symptoms and supporting renal function until spontaneous recovery occurs, which is common in pediatric PSGN cases. Antibiotic therapy, such as a 10-day course of penicillin, aims to eradicate residual streptococci and prevent recurrence (Roth et al., 2019). Blood pressure control with antihypertensives, fluid management, and electrolyte balance are critical, as elevated BUN and creatinine levels indicate significant renal impairment. The patient's kidney function normalized within six weeks, illustrating the generally favorable prognosis of PSGN in children (Kumar & Abbas, 2021).

Monitoring renal function is vital; BUN and serum creatinine levels indicate severity, with dialysis being necessary if levels become life-threatening or if uremic symptoms develop. Typically, dialysis is considered when BUN exceeds 80-100 mg/dL, serum potassium is dangerously high, or signs of neurological deterioration appear (Niaudet, 2020).

Understanding Hypertension in PSGN

The patient's hypertension results from fluid retention, increased systemic vascular resistance due to endothelial injury, and activation of the renin-angiotensin-aldosterone system (RAAS) (Choi et al., 2018). Addressing hypertension promptly reduces the risk of cardiovascular complications and further renal damage.

Complication Management

In the scenario of developing a swollen mouth and neck following contrast imaging like IVP, concern would escalate towards airway compromise due to angioedema or severe allergic reaction. Immediate steps include airway assessment, administration of antihistamines or corticosteroids, and securing the airway if swelling obstructs respiration (Simons et al., 2017). Emergency intervention with airway stabilization—potentially intubation or surgical management—would be warranted to prevent suffocation.

Conclusion

The case underscores the importance of early recognition and management of poststreptococcal glomerulonephritis. Proper supportive care, blood pressure control, and vigilant monitoring can lead to full recovery, especially in children. Understanding the underlying immunological mechanisms, diagnostic criteria, and potential complications are essential for clinicians managing pediatric renal inflammatory diseases.

References

  • Choi, H. D., Kim, H. J., & Lee, S. H. (2018). Pediatric glomerulonephritis: An overview. Kidney Research and Clinical Practice, 37(4), 345–352. https://doi.org/10.23876/j.krcp.2018.37.4.345
  • Kumar, Abbas, A. K., & Aster, J. C. (2021). Robbins Basic Pathology (10th ed.). Elsevier.
  • Niaudet, P. (2020). Management of pediatric glomerular diseases. Seminars in Nephrology, 40(1), 56–68. https://doi.org/10.1016/j.semnephrol.2020.01.005
  • Roth, D. M., Kumar, S., & Sharma, S. (2019). Post-streptococcal glomerulonephritis: Pathogenesis and clinical features. Journal of Pediatric Nephrology, 22(3), 367–373. https://doi.org/10.1007/s00467-019-04189-y
  • Simons, F. E., Ardusso, L. R., Bilo, M. B., et al. (2017). World Allergy Organization anaphylaxis guidelines: 2017 update. World Allergy Organ J, 10, 10. https://doi.org/10.1186/s40413-017-0174-4
  • Roth, D. M., Kumar, S., & Sharma, S. (2019). Post-streptococcal glomerulonephritis: Pathogenesis and clinical features. Journal of Pediatric Nephrology, 22(3), 367–373. https://doi.org/10.1007/s00467-019-04189-y
  • Niaudet, P. (2020). Management of pediatric glomerular diseases. Seminars in Nephrology, 40(1), 56–68. https://doi.org/10.1016/j.semnephrol.2020.01.005
  • Kumar, Abbas, A. K., & Aster, J. C. (2021). Robbins Basic Pathology (10th ed.). Elsevier.
  • Choi, H. D., Kim, H. J., & Lee, S. H. (2018). Pediatric glomerulonephritis: An overview. Kidney Research and Clinical Practice, 37(4), 345–352. https://doi.org/10.23876/j.krcp.2018.37.4.345
  • Simons, F. E., Ardusso, L. R., Bilo, M. B., et al. (2017). World Allergy Organization anaphylaxis guidelines: 2017 update. World Allergy Organ J, 10, 10. https://doi.org/10.1186/s40413-017-0174-4

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