Syed Kashif Abbas, Shiyam Sundar Tikmani, Afroze Ramazan Sherali.
Clinical presentation of Poststreptococcal Glomerulonephritis and response with optimal management.
Med Channel Jan ;13(2):32-5.

OBJECTIVES:- To find out presentation of PSAGN in children at NICH. To determine immediate outcome with optimal management strategy. STUDY DESIGN: Descriptive type Analytical study. PLACE AND DURATION OF STUDY: National Institute of child Health, conducted from January to December 2001. PATIENTS AND METHODS: The study included 40 patients who had fulfilled criteria of selection were included. Inclusion criteria were age group 5 to 15 years belonging to both sex with gross hematuria ( naked eye observation) or microscopic hematuria (> 5 R.B.C/H.P.F) on urinalysis, hypertension and edema. Patients with raised ASO titer; R.B. C cast in urine and low C3 level were in favor of PSAGN. All patients of CRF, urinary calculi, congenital urinary tract anomalies and connective tissue disorders were excluded. Clinically suspected PSAGN or Nephrotic Syndrome but not proved on investigation as PSAGN were also excluded. RESULTS: We recorded an increased prevalence of PSAGN in 5-9 years of age 60% with high male to female ratio. Most of cases were admitted through casualty 92% during winter season, 50%. Oliguria and irritability for 3 days were noted in 98% of cases beside gross hematuria, edema and hypertension last for 5 days. Breathlessness was noted in 72% mostly due to pulmonary edema. Signs of encephalopathy were also seen in 20% of cases while papilledema in 18%. Strategy of supportive treatment of PSAGN was adopted for all patients, which included penicillin therapy, fluid and salt restriction and use of loop diuretics, 22% of hypertensive encephalopathy required injectable diazepam to control fits. 2 out of 40 patients developed refractory type of ARF with pulmonary edema needed dialysis. Most patients (88%) recovered within 2 weeks while ( 15%) recovered within next 2 weeks. CONCLUSION: Every child with gross hematuria, edema, pallor and hypertension be investigated for PSAGN. Optimal management strategy for PSAGN should be adopted as soon as possible in patients with these clinical features because to prevent acute phase complication of PSAGN.

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