A Pediatric Clinical Case Study
Pediatric
Post-Streptococcal Acute Glomerulonephritis Complicated by Acute Renal Failure
1.
Patient Information
- Age:
8 years
- Sex:
Male
- Date of Admission:
31 October 2007
- Date of Discharge:
9 November 2007
- Final Diagnosis:
Post-streptococcal acute glomerulonephritis complicated by acute renal
failure
2.
Chief Complaints
The patient presented with:
- Facial and eyelid puffiness for 3 days
- Brown-colored urine
- Decreased urine output (oliguria)
3.
History of Present Illness
An 8-year-old male child presented
with a 3-day history of facial and periorbital puffiness. The parents also
reported brown-colored urine associated with a significant reduction in urine
output.
There was no reported history of
jaundice, fever, lethargy, irritability, or seizures. There was no previous
history of similar episodes.
4.
Physical Examination
At admission:
- Heart rate:
76 beats/min
- Respiratory rate:
28 breaths/min
- Blood pressure:
108/80 mmHg
- General examination:
Facial and periorbital puffiness with pretibial edema
- Abdominal examination: Liver just palpable
- Other systemic examination: No significant abnormality detected
During hospitalization, the patient
developed significant hypertension, with blood pressure reaching a maximum of
approximately 160/100 mmHg.
5.
Investigations
Hematological
Investigations
- Hemoglobin: 12.4 g/dL
- Total leukocyte count: 7,800/mm³
- ESR: 8 mm/hr
Urinalysis
Urinalysis demonstrated:
- Proteinuria: +++
- Numerous red blood cells
- Pus cells
Serological
Investigations
- Antistreptolysin O (ASO) titre: Positive
- C-reactive protein (CRP): Positive
These findings supported a recent
streptococcal infection.
Renal
Function Tests
- Serum urea at admission: 93 mg/dL
- Peak serum urea: 115 mg/dL on 1 November 2007
- Serum creatinine: approximately 1.4–1.5 mg/dL during
the first week
Other
Investigations
- Chest X-ray
- Electrocardiogram (ECG)
- Ultrasonography (USG)
These investigations were performed
as part of the initial evaluation and monitoring.
6.
Diagnosis
Based on the clinical presentation,
urinalysis, positive ASO titre, renal function abnormalities, edema, oliguria,
and hypertension, the patient was diagnosed with:
Post-streptococcal acute
glomerulonephritis (PSAGN) complicated by acute renal failure.
7.
Management
Management was directed toward
controlling fluid overload, edema, hypertension, and the underlying
streptococcal infection.
Dietary
Management
- Low-salt diet
- Low-protein diet
- High-carbohydrate diet
Fluid
Management
Strict monitoring of fluid intake
and urine output was maintained, with fluid management adjusted according to
the patient's clinical status and losses.
Pharmacological
Management
Diuretics:
- Frusemide (Lasix) was administered for management of
edema and fluid overload.
Antihypertensive therapy:
- Nifedipine: 5 mg, administered as prescribed (TID/BD)
- Atenolol: 25 mg once daily
Antibiotic therapy:
- Penicillin: 4 lakh units intramuscularly for 5 days
8.
Activity
The patient was advised bed rest
during the acute phase of illness. Heavy physical activity was avoided during
follow-up.
9.
Clinical Course
The patient showed progressive
clinical improvement during hospitalization, with improvement in edema and
overall clinical status.
He was discharged on 9 November
2007 in stable condition, with a body weight of 19.7 kg.
10.
Follow-Up
Follow-Up
on 19 November 2007
The patient continued to show
clinical improvement. His weight was recorded as 19.75 kg.
Follow-Up
on 23 November 2007
The patient was clinically well. His
weight was 19.9 kg, and blood pressure had decreased to 88/58 mmHg.
Urinalysis continued to show:
- Slightly brown-colored urine
- Numerous RBCs
- Protein: +
Renal function showed improvement:
- Serum urea: 32 mg/dL
- Serum creatinine: 1.2 mg/dL
The patient was advised to continue
adequate rest and avoid heavy physical exercise.
11.
Outcome
The patient demonstrated clinical
and biochemical improvement following conservative management of
post-streptococcal acute glomerulonephritis with acute renal impairment.
Renal parameters improved
substantially during follow-up, with serum urea decreasing from a peak of 115
mg/dL to 32 mg/dL and serum creatinine decreasing to 1.2 mg/dL.
12.
Clinical Summary
This case represents a pediatric
presentation of post-streptococcal acute glomerulonephritis
characterized by periorbital and peripheral edema, oliguria, brown-colored
urine, proteinuria, hematuria, hypertension, and impaired renal function.
Positive ASO serology supported a recent streptococcal infection. The patient
responded to fluid and dietary restriction, diuretic and antihypertensive
therapy, and antibiotic treatment, with subsequent improvement in renal
function and clinical status.
References
VanDeVoorde RG. Acute poststreptococcal glomerulonephritis. Pediatr Rev. 2015;36(1):3–13. — USA
NHS Greater Glasgow and Clyde. Glomerulonephritis: Paediatric Renal Unit Guideline. — UK
Meena J, et al. AsPNA Clinical Practice Guidelines for the management of infection-related glomerulonephritis. Pediatr Nephrol. 2026;41(6):1867–1881. — India/Asia
Medical Disclaimer: The information provided in this article is strictly for educational, study, and exam-preparation purposes. It does not constitute professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for clinical decisions.
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