ACUTE GLOMERULONEPHRITIS (AGN)

This is an inflammatory renal disease commonly following streptococcal infection of skin and tonsils.

Clinical Features

  • The patient presents with smoky or tea coloured urine as a result of haematuria
  • Oedema that manifests as puffiness of the eyes, more noticeable in the morning. The oedema is seldom severe or generalized.
  • Experience back pain
  • Hypertension – commonly presenting as headaches – visual disturbance,
  • Vomiting.
  • Occasionally the patients may present with pulmonary oedema with dyspnoea or convulsions and coma due to hypertensive
    encephalopathy.
  • There may be evidence of primary streptococcus infection, most often as an acute follicular tonsillitis with cervical adenitis and less often as skin sepsis.
  • In the initial stages of the illness there is oliguria that is followed by diuresis (oliguric – diuretic phases).

Investigations

  • Urinalysis: RBC, RBC casts and WBC. Granular and hyaline casts, mild to moderate proteinuria.
  • Blood urea: Moderately high in oliguric phase; otherwise normal.
  • Antistreptolysin O titre: Increased except in those with a skin primary cause where it remains normal.
  • Throat and skin swab where indicated, but culture may be negative. Streptococcus may be cultured.

Management

  • Admit the child.
  • Give penicillin or amoxicillin for 10 days.
  • Monitor fluid intake, urine output, weight, and BP daily.
  • Restrict fluid input in oliguric phase: child <5 years 300ml/day and child >5 years 500ml/day in addition to urine output.
  • Order a high calorie, low salt and protein diet in oliguric phase.
  • Treat hypertension if present [see hypertension].
  • Monitor electrolytes, urea, and creatinine daily especially in the oliguric phase.

 Refer to specialist if in acute renal failure.