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Tzvi-Behr S, Frishberg Y, Megged O, Weinbrand-Goichberg J, Becher-Cohen R, Terespolsky H, Rinat C, Choshen S, Ben-Shalom E. Acute glomerulonephritis with concurrent suspected bacterial pneumonia - is it the tip of the iceberg? Pediatr Nephrol 2024; 39:1143-1147. [PMID: 37943374 DOI: 10.1007/s00467-023-06217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Post infectious glomerulonephritis is the most common glomerulopathy in children, occurring several weeks after nephritogenic streptococcal throat or skin infection. Reports of acute glomerulonephritis (AGN) occurring during active bacterial pneumonia in children are rare. The aim of this study was to evaluate the incidence of AGN concurrent with bacterial pneumonia in children. METHODS We reviewed records of all children admitted with a diagnosis of pneumonia to the pediatric department in a single tertiary medical center between January 2015 and April 2023. Patients with bacterial pneumonia and concurrent glomerulonephritis were included. RESULTS Eleven (0.98%) of 1,123 patients with bacterial pneumonia had concurrent AGN. All were males with a median age of 2.7 years (range 1-13). Mean time from bacterial pneumonia onset to acute glomerulonephritis symptoms was 2.7 ± 1.5 days. Five (45%) patients had evidence of pneumococcal infection. Hypertension was found in 10 (91%) patients. Mean trough eGFR was 43.5 ± 21.4 ml/min/1.73 m2 (range 11-73). Ten patients (91%) had low C3 levels. Median urinary protein-to-creatinine ratio was 2.5 mg/mg (IQR 2.15-14.75). All patients fully recovered. Microscopic hematuria was the last finding to normalize after a median of 29.5 days (IQR 17.25-38). CONCLUSION AGN during bacterial pneumonia may be more frequent than previously recognized. Kidney prognosis was excellent in all patients. Prospective studies are needed to evaluate the impact of this condition.
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Affiliation(s)
- Shimrit Tzvi-Behr
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel.
| | - Yaacov Frishberg
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Orli Megged
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | | | - Rachel Becher-Cohen
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Hadass Terespolsky
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Choni Rinat
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Sapir Choshen
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Efrat Ben-Shalom
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
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Yoǧurtçuoǧlu B, Damar Ç. Renal elastography measurements in children with acute glomerulonephritis. Ultrasonography 2021; 40:575-583. [PMID: 33906284 PMCID: PMC8446499 DOI: 10.14366/usg.20173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/10/2021] [Accepted: 03/04/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The aim of this study was to compare the acoustic radiation force impulse elastography (ARFI-e) values of the renal cortical parenchyma in children with acute glomerulonephritis (AGN) and healthy children, and to determine a cut-off point for the diagnosis of AGN. METHODS This prospective study included 30 children with biopsy-proven AGN and 30 healthy children. All the children underwent renal ARFI-e measurements. Values were obtained from the upper, middle, and lower zones of the right kidney parenchyma. A total of nine ARFI-e measurements (three from each zone) were made. Statistical analyses were conducted of the mean elastography values (MEVs) of the children in both groups. RESULTS In the patient group, the MEVs measured from the upper, middle and lower zones of the right kidney were 3.42±0.42 m/s, 3.45±0.45 m/s, and 3.39±0.39 m/s (average, 3.42±0.34 m/s), respectively. In the healthy control group, the MEVs measured from the upper, middle, and lower zones of the right kidney were 2.85±0.63 m/s, 2.85±0.68 m/s, and 2.86±0.66 m/s (average, 2.85±0.57 m/s), respectively. The MEVs in all zones were significantly higher in the patient group than in the healthy group (P<0.001). The cut-off values determined to predict AGN in the upper, middle, and lower zones of the kidney were 2.74 m/s (sensitivity, 96.67%; specificity, 46.67%), 2.71 m/s (sensitivity, 96.67%; specificity, 53.33%), and 2.81 m/s (sensitivity, 93.33%; specificity, 56.67%), respectively. CONCLUSION The ARFI-e technique can be considered as a non-invasive, easily applicable, auxiliary method for the early diagnosis of AGN.
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Affiliation(s)
- Burak Yoǧurtçuoǧlu
- Department of Radiology, Faculty of Medicine, Gaziantep University, Üniversite Bulvarı, Șehitkamil, Turkey
| | - Çaǧrı Damar
- Department of Radiology, Faculty of Medicine, Gaziantep University, Üniversite Bulvarı, Șehitkamil, Turkey
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Malaga-Dieguez L, Trachtman H, Giusti R. Pulmonary Manifestations of Renal Disorders in Children. Pediatr Clin North Am 2021; 68:209-222. [PMID: 33228933 DOI: 10.1016/j.pcl.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The causes of kidney disease in pediatric patients are evenly divided between congenital abnormalities of the kidney and urinary tract and acquired disorders. Nearly 10% to 15% of adults in the United States have chronic kidney disease (CKD); there are no comparable data in children. Regardless of patient age, CKD is a systemic problem that affects every organ system, including the lung. We review the tests used to diagnose and evaluate kidney disease and the main clinical syndromes that are likely to be encountered to aid the pulmonology consultant who is asked to evaluate patients with kidney disease.
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Affiliation(s)
- Laura Malaga-Dieguez
- Division of Pediatric Nephrology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA.
| | - Howard Trachtman
- Division of Pediatric Nephrology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA
| | - Robert Giusti
- Division of Pediatric Pulmonology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA
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Ge H, Wang X, Deng T, Deng X, Mao H, Yuan Q, Xiao X. Clinical characteristics of acute glomerulonephritis with presentation of nephrotic syndrome at onset in children. Int Immunopharmacol 2020; 86:106724. [PMID: 32593976 DOI: 10.1016/j.intimp.2020.106724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/30/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Acute glomerulonephritis (AGN) is a common disease in children, which places a huge burden on developing countries. The prognosis of it may not always be good. However, the clinical characteristics of AGN with nephrotic syndrome (NS) at onset have not been fully clarified. METHODS One hundred and thirteen cases were analyzed retrospectively. Clinical data, pathological results and prognosis between AGN with NS (AGN-NS) and AGN without NS (AGN-no-NS) were compared. RESULTS Twenty (17.7%) of 113 patients were AGN-NS. The patients with AGN-NS were more likely to have hypertension (55.0% vs. 25.8%) and acute kidney injury (AKI) (50.0% vs. 17.2%). AKI was significantly related to the manifestation of AGN-NS in children (OR = 3.812, P = 0.040). Compared with the AGN-no-NS, the immunosuppressive treatments were more common in AGN-NS. A more severe pathological grade was significantly related to lower C3 fraction, estimated glomerular filtration rate (eGFR), and AKI, but not to the performance of AGN-NS. There was no difference in prognosis between the two groups. CONCLUSIONS AKI was significantly associated with AGN-NS. The prognosis of AGN-NS and AGN-no-NS in our study was almost good. Given the fact that AGN-NS patients are more likely to use immunosuppressive therapy, the long-term outcome of AGN-NS warrants further research.
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Affiliation(s)
- Huipeng Ge
- Department of Nephrology, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China
| | - Xiufen Wang
- Department of Nephrology, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China
| | - Tianci Deng
- Department of Nephrology, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China
| | - Xiaolu Deng
- Department of Pediatrics, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China
| | - Huaxiong Mao
- Department of Pediatrics, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China
| | - Qiongjing Yuan
- Department of Nephrology, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China.
| | - Xiangcheng Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China.
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Salam Salih SA, Elbashier AMA, Alameen NAA. Familial Kawasaki disease and acute glomerulonephritis: case report and review of literature. Sudan J Paediatr 2020; 20:68-72. [PMID: 32528204 DOI: 10.24911/sjp.106-1548975790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report two siblings, a 6-year-old boy and his 4-year-old sister who were admitted with fever for 15 days and features of Kawasaki disease. After admission to the hospital, both patients developed red urine and headache. Blood pressure was found to be high in relation to blood pressure percentiles for both patients. Urine analysis showed the features of acute glomerulonephritis with normal urine output and renal function. A multidisciplinary discussion with the paediatric nephrologist, rheumatologist and cardiologist was conducted, and intravenous immunoglobulins, aspirin, pulsed methylprednisolone and antihypertensive therapy were added to the treatment plan with a good outcome.
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Affiliation(s)
- Sarah A Salam Salih
- Department of Paediatrics and Child health, School of Medicine, Ahfad University for Women, Omdurman, Sudan
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Lee KY. A unified pathogenesis for kidney diseases, including genetic diseases and cancers, by the protein-homeostasis-system hypothesis. Kidney Res Clin Pract 2017; 36:132-144. [PMID: 28680821 PMCID: PMC5491160 DOI: 10.23876/j.krcp.2017.36.2.132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/20/2016] [Accepted: 02/02/2017] [Indexed: 12/14/2022] Open
Abstract
Every cell of an organism is separated and protected by a cell membrane. It is proposed that harmony between intercellular communication and the health of an organism is controlled by a system, designated the protein-homeostasis-system (PHS). Kidneys consist of a variety of types of renal cells, each with its own characteristic cell-receptor interactions and producing characteristic proteins. A functional union of these renal cells can be determined by various renal function tests, and harmonious intercellular communication is essential for the healthy state of the host. Injury to a kind of renal cells can impair renal function and induce an imbalance in total body health. Every acute or chronic renal disease has unknown etiologic substances that are responsible for renal cell injury at the molecular level. The immune/repair system of the host should control the etiologic substances acting against renal cells; if this system fails, the disease progresses to end stage renal disease. Each renal disease has its characteristic pathologic lesions where immune cells and immune proteins, such as immunoglobulins and complements, are infiltrated. These immune cells and immune proteins may control the etiologic substances involved in renal pathologic lesions. Also, genetic renal diseases and cancers may originate from a protein deficiency or malfunctioning protein under the PHS. A unified pathogenesis for renal diseases, including acute glomerulonephritis, idiopathic nephrotic syndrome, immunoglobulin A nephropathy, genetic renal diseases such as Alport syndrome, and malignancies such as Wilms tumor and renal cell carcinoma, is proposed using the PHS hypothesis.
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Affiliation(s)
- Kyung-Yil Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Pediatrics, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
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Naqvi R, Mubarak M, Ahmed E, Akhtar F, Bhatti S, Naqvi A, Rizvi A. Spectrum of glomerular diseases causing acute kidney injury; 25 years experience from a single center. J Renal Inj Prev 2015; 4:113-6. [PMID: 26693497 PMCID: PMC4685980 DOI: 10.12861/jrip.2015.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/29/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is common in nephro-urological practice. Its incidence, prevalence and etiology vary widely, mainly due to variations in the definitions of AKI. OBJECTIVES We aim to report the spectrum of glomerular diseases presenting as AKI at a kidney referral center in Pakistan. PATIENTS AND METHODS An observational cohort of patients identified as having AKI which was defined according to RIFLE criteria, with normal size, non-obstructed kidneys on ultrasonography, along with active urine sediment, edema and new onset hypertension. RESULTS From 1990 to 2014, 236 cases of AKI secondary to acute glomerulonephritis (AGN) registered at this institution. Mean age of patients was 27.94± 12.79 years and M:F ratio was 0.77:1. Thirty percent patients revealed crescents on renal biopsy. AGN without crescents was seen in 33.05% of cases. Postinfectious GN was found in 14.4%, lupus nephritis in 8.5% and mesangiocapillary GN in 3.4% cases. Renal replacement therapy (RRT) required in 75.84% patients. Pulse steroids were given in 45.33% cases followed by oral steroids. Pulse cyclophoshphamide was given in 23.7% cases and plasmapheresis was used in 3.38% cases. Complete recovery was seen in 44%, while 11.44% died during acute phase of illness. About 19.49 % developed chronic kidney disease (CKD) and 25.84% were lost to long- term follow-up. CONCLUSION Although glomerular diseases contribute only 4.19 % of total AKI at this center, morbidity associated with illness and its treatment is more marked than other AKI groups. Another notable factor is late referral of these patients to specialized centers resulting in undesirable outcome.
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Affiliation(s)
- Rubina Naqvi
- Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
,Corresponding author: Prof. Rubina Naqvi,
| | - Muhammed Mubarak
- Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Ejaz Ahmed
- Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Fazal Akhtar
- Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Sajid Bhatti
- Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Anwar Naqvi
- Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Adib Rizvi
- Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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Xu JM, Wang R. Diffuse mesangial and endocapillary cell proliferative glomerulonephritis with persistent hypocomplementemia in a child. Int J Clin Exp Med 2015; 8:16834-16837. [PMID: 26629229 PMCID: PMC4659117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
A 15-year-old boy was admitted to People's Hospital of Dong E with anasarca. The laboratory findings revealed proteinuria, hematuria, hypocomplementemia. Renal biopsy specimen revealed diffuse mesangial and endocapillary cell proliferative glomerulonephritis on light microscopic (LM) examination. On immunofluorescence (IF) examination, deposition of IgG, IgA, C3, C1q and F to capillary wall and subendothelial were observed. By means of electron microscopy (EM), subendothelial electron-dense deposits and segmental fusion of epithelial cell foot process were recognized. He was treated by only some supportive drugs, no ACEI/ARB, without glucocorticoids and immunosuppressive agents. About one month later, complete remission of proteinuria occurred. During next 62-weeks follow up, urinary analysis always showed microscopic hematuria. However, it is interesting to note that the serum complement C3 and C4 levels remained persistently low.
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Affiliation(s)
- Jun-Mei Xu
- Shandong UniversityJinan 250100, P. R. China
- Department of Nephrology, People’s Hospital of Dong E countyLiaocheng 252200, People’s P. R. China
| | - Rong Wang
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021, P. R. China
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Abstract
Acute kidney injury (AKI) is an important cause of hospitalization and morbidity in human immunodeficiency virus (HIV)-positive patients. However, the data on AKI in such patients is limited. The aim of the present study was to analyze the incidence, causes and outcome of AKI in HIV-positive patients from our antiretroviral therapy centre. All HIV-positive patients were evaluated for evidence of clinical AKI. AKI was noted in 138/3540 (3.9%) patients. Of 138 AKI patients, 96 (69.6%) had acquired immuno deficiency syndrome and 42 (30.4%) were HIV seropositive. Majority of AKI patients belonged to AKI network (AKIN) Stage II (42%) or III (48.5%) at presentation. Prerenal, intrinsic and postrenal AKI were noted in 53.6%, 44.2% and 2.2% of cases, respectively. Hypovolemia (44.2%) and sepsis (14.5%) contributed to AKI in vast majority of cases. AKI was multifactorial (volume depletion, sepsis and drugs) in 39% of patients. Acute tubular necrosis (ATN) was the most common intrinsic lesion. Acute interstitial nephritis and diffuse endocapillary proliferative glomerulonephritis were noted in five and two cases, respectively. In-hospital mortality was 24.64%. Lower CD4 count, decreased serum albumin level and Stage 4 WHO disease were associated with higher mortality. At 3 months or more follow-up complete recovery of renal function, chronic kidney disease Stage 3-5 and progression to end stage renal disease were noted in 58.69%, 14.5% and 2.2% of cases, respectively. Thus, prerenal factors and ischemic ATN were the most common cause of AKI in HIV-infected patients. Recovery of renal function was seen in 59% of cases, but AKI had high in-hospital mortality.
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Affiliation(s)
- J Prakash
- Department of Nephrology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
| | - T Gupta
- Department of Medicine, TNMC, Mumbai, Maharashtra, India
| | - S Prakash
- Department of Medicine, TNMC, Mumbai, Maharashtra, India
| | - S S Rathore
- Department of Nephrology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
| | - Usha
- Department of Pathology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
| | - S Sunder
- Department of Medicine, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
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Kasap B, Çarman KB, Yiş U. A case of acute post-streptococcal glomerulonephritis that developed posterior reversible encephalopathy syndrome. Turk Pediatri Ars 2014; 49:348-352. [PMID: 26078688 PMCID: PMC4462310 DOI: 10.5152/tpa.2014.430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/21/2013] [Indexed: 06/04/2023]
Abstract
A 10-year male patient presented with swelling in the face, legs and scrotal area which developed 8 days after tonsillitis treatment. Acute post-sterotococcal glomerulonephritis (APSGN) was considered in the patient whose urinalysis revealed hematuria and proteinuria at nephrotic level, whose urea, creatinine, lipid profile and anti-streptolysine O antibody levels were increased, albumin and C3 value were decreased and whose 24-hour urine test revealed proteinuria. Renal biopsy was found to be compatible with APSGN. In the follow-up, severe headache, vomiting and convulsion were observed under antihypertensive and diuretic treatment and when the blood pressure was 130/80 mmHg (the 99(th) percentile for the patient: 129/88 mmHg). During the follow-up, the blood pressure values increased to 160/90 mmHg. The electroencephalogram (EEG) performed was found to be normal and magnetic resonance imaging (MRI) findings were compatible with posterior reversible encephalopathy syndrome (PRES). MRI was found to be normal at the first month following antihypertensive and anticonvulsive treatment. In the first year of the follow-up, the blood pressure, neurological examination and urinalysis findings were found to be normal. This patient was presented to draw attention to the fact that PRES can also present with a blood pressure tending to increase and with blood pressure values which are not so high.
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Affiliation(s)
- Belde Kasap
- Clinic of Pediatric Nephrology, Gaziantep Childrens’ Hospital, Gaziantep, Turkey
| | - Kürşat Bora Çarman
- Clinic of Pediatric Neurology, Gaziantep Childrens’ Hospital, Gaziantep, Turkey
| | - Uluç Yiş
- Clinic of Pediatric Neurology, Gaziantep Childrens’ Hospital, Gaziantep, Turkey
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Odaka J, Kanai T, Ito T, Saito T, Aoyagi J, Betsui H, Oda T, Ueda Y, Yamagata T. A case of post-pneumococcal acute glomerulonephritis with glomerular depositions of nephritis-associated plasmin receptor. CEN Case Rep 2014; 4:112-116. [PMID: 28509278 DOI: 10.1007/s13730-014-0149-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022] Open
Abstract
We report the case of a 12-year-old girl who was referred to our hospital with anuria associated with pneumonia. On admission, the patient's blood test results revealed severe renal failure, hypoproteinemia, and hypocomplementemia. Her urinalysis results revealed hematuria, proteinuria, and a positive titer for Streptococcus pneumoniae. S. pneumoniae was also detected in her sputum and blood cultures. The patient was diagnosed with post-pneumococcal acute glomerulonephritis (AGN) with acute renal failure. A renal biopsy demonstrated the infiltration of neutrophils and mononuclear cells into capillary loops. Immunofluorescence studies showed dominant-positive deposition of C3c along the capillary loops and nephritis-associated plasmin receptor (NAPlr) depositions in the mesangial area and capillary loops. Electron microscopy revealed dense deposits in the glomerular basement membrane without a hump in the subepithelial area. These findings were consistent with endocapillary proliferative glomerulonephritis. AGN associated with pneumococcal infection is very rare. This case suggests that NAPlr is the causative antigen not only of post-streptococcal AGN, but also of post-pneumococcal AGN. To our knowledge, this is the first report that shows a relationship between post-pneumococcal AGN and NAPlr depositions in the glomeruli.
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Affiliation(s)
- Jun Odaka
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Takahiro Kanai
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takane Ito
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takashi Saito
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Jun Aoyagi
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hiroyuki Betsui
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takashi Oda
- Department of Nephrology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Yoshihiko Ueda
- Department of Pathology, Koshigaya Hospital, Dokkyo Medical University Saitama, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Takanori Yamagata
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Kumar S. S, M. K, S. S, Sampath S, Kasthuri RK. Posterior reversible encephalopathy syndrome unmasking acute glomerulonephritis. J Clin Diagn Res 2014; 8:177-8. [PMID: 24596763 PMCID: PMC3939544 DOI: 10.7860/jcdr/2014/6465.3818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 09/21/2013] [Indexed: 11/24/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a recently described condition, wherein there is vasogenic oedema, seen on neuroimaging, predominantly over the parieto occipital regions of the cerebrum. Though, as the name implies, the condition is reversible, there may be fatalities and neurological sequelae. We are reporting a 9-year-old female child in whom the typical clinical and neurological findings of PRES were caused by an atypical presentation of acute glomerulonephritis.
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Affiliation(s)
- Sathish Kumar S.
- Senior Resident, Department of Pediatrics, ESI PGI MSR, K.K.Nagar Chennai, India
| | - Kumar M.
- Assistant Professor, Department of Pediatrics, ESI PGI MSR, K.K.Nagar Chennai, India
| | - Shobhana S.
- Associate Professor, Department of Pediatrics, ESI PGI MSR, K.K.Nagar Chennai, India
| | - Sowmya Sampath
- Professor, Department of Pediatrics, ESI PGI MSR, K.K.Nagar Chennai, India
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Abstract
The association between hypertensive encephalopathy and cortical blindness in children with acute glomerulonephritis is extremely rare. We report the case of a 9-year old girl who presented with headache, seizures, altered sensorium, hematuria, and transient cortical blindness as a complication of hypertensive encephalopathy which showed complete reversal following normalization of blood pressure and an underlying post-infectious acute glomerulonephritis was revealed.
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Affiliation(s)
- K Kaarthigeyan
- Department of Pediatrics, Pediatric Intensive Care Unit, PSG Institute of Medical Sciences and Research, Coimbatore, India
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