Abstract: SA-PO251
PSGN – When Kidneys Take a Hit
Session Information
- Trainee Case Reports - V
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1202 Glomerular Diseases: Immunology and Inflammation
Authors
- Deen, Muhammad, University of Illinois College of Mediicine at Peoria, Peoria, Illinois, United States
- Oni, Omomengbe, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
- Na'Allah, Rahmat, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
Introduction
Complication of Streptococcal pharyngitis leading to post-streptococcal glomerulonephritis.
Case Description
12 year old boy presented with hematuria, oliguria, arthralgia, periorbital and peripheral edema in the setting of acute kidney injury. 10 days prior to admission, patient was diagnosed with recurrent strep throat infection which was treated with Amoxicillin-Clavulanic acid. Examination findings were positive for diffuse maculopapular rash and presence of cola colored urine. On admission, lab work was significant for Cr 1.10 (baseline Cr 0.50), elevated ASO titer 983, DNase B Ab 1390 and UA positive for blood and protein. What was surprising, that the patient had normal complement (C3 and C4) levels at presentation. Appropriate fluid resuscitation was initiated, resulting in an improvement in urine output and renal function, but a fall in C3 and total complement levels was noted. Given this atypical presentation, along with possible concerns for other forms of vasculitis especially Henoch Schonlein Purpura, a short burst of steroid treatment was initiated. Patient showed significant clinical improvement with complete resolution of hematuria, oliguria, proteinuria, edema and rash. Follow up with PCP and nephrology in 6 weeks revealed a normal complement level and given this scenario, a diagnosis of post-streptococcal glomerulonephritis (PSGN) was made.
Discussion
The hallmark of GN is inflammation within the glomeruli that typically manifests as hematuria and proteinuria. Renal function may be reduced, depending on the severity of the acute condition or the presence of chronic glomerular injury.
Post-streptococcal glomerulonephritis is the leading cause of acute nephritic syndrome. Most cases are sporadic, although the disease has been known to occur in epidemic form. The overall incidence of PSGN in the United States has significantly decreased with good long term prognosis. More than 95% of patients recover spontaneously and return to baseline renal function within three to four weeks with no long term sequelae. Acute PSGN usually is diagnosed on clinical and serologic grounds without the need for biopsy, especially in children with a typical history.