Case 5 Flashcards
What is the most common cause of acute nephritis in kids worldwide?
post streptococcal glomerulonephritis
How much more common is PSGN in males than females ?
twice as common
PSGN develops how many weeks after pharyngitis ?
1-3 weeks
what are the 3 most common presenting symptoms of PSGN?
- generalized edema
- gross hematuria
- HTN
What are some of the other presenting symptoms of PSGN?
red/brown urine, proteinuria, elevated serum creatinine, headache, malaise, anorexia, and flank pain
UA results for PSGN?
RBCs, red cell casts, proteinuria
Will serum complement be low or high in PSGN?
LOW, because complement components (part of the innate immune system) are being consumed
which two serology tests will show evidence of a recent streptococcal infection?
ASO and anti-DNAse
-of note: a streptozyme test can also be used
What other lab value might you see increased in PSGN?
BUN/Cr
What is needed to make the PSGN diagnosis?
- clinical finding of acute nephritis PLUS
- demonstration of a recent GAS infection (+ throat, skin culture or serology test)
How would you treat mild volume overload in children with PSGN?
sodium and water restriction
Which medication would you use to reduce BP and edema in children if severe?
loop diuretics, usually furosemide
When is dialysis indicated in management of PSGN?
- life threatening fluid overload (ex. pulmonary edema, heart failure, severe HTN) refractory to meds
- hyperkalemia > 6.5 unresponsive to meds
- uremia with BUN between 89-100
What are the criteria for admission of patients with PSGN?
- severe renal dysfunction
- oliguria
- severe HTN
- CHF
- significant volume overload
Which antibiotics would be used to treat PSGN?
1st line: penicillin
2nd line: amoxicillin
3rd line: for PCN allergy, cephalexin
-if they cant take cephalosporins –> azithromycin
How long does it take for hematuria to resolve after PSGN?
3-6 months
When does creatinine usually return back to baseline ?
by 3-4 wks
What is the most common cause of heart disease in kids in developing countries?
rheumatic fever
When do rheumatic fever symptoms usually start?
10 days - several weeks after GAS infection
S/S of rheumatic fever?
acute febrile illness with joint manifestations and or carditis, neurologic and behavioral manifestations with chorea
Fever is present in what percent of RF cases?
> 90% of cases
Describe the joint pain in RF.
- generally larger joints
- migratory
- dramatic response to NSAIDS/salicylates
Describe the rash in RF.
erythema marginatum:
- non pruritic
- non painful
- evanescent
- usually on the trunk
- may have central pallor
How many of the Jones Criteria are needed to diagnose ?
-2 major OR
-1 major + 2 minor
AND evidence of strep infection
Name the major jones criteria.
- carditis and valvulitis
- arthritis (migratory usually)
- CNS involvement (chorea usually)
- subcutaneous nodules
- erythema marginatum
Name the minor jones criteria.
- arthralgia
- fever
- elevated acute phase reactants
- prolonged PR on EKG
Name the 3 main cardiac/EKG findings in RF.
- PR prolongation (AV block)
- mitral valve most commonly effected valvulitis
- mitral regurgitation
*there are others to on the slides, but Paulson pointed out these 3 specifically
Treatment of acute rheumatic fever ?
- PCN for the strep infection
- NSAIDs for arthritis (aspirin 1st line)
- carditis management
- prophylaxis bc they are at risk for recurrence
What type of hypersensitivity reaction is rheumatic fever?
type II –> antibody directed against antigen on cells or extracellular materials
What type of hypersensitivity reaction is Postreptococcal glomerulonephritis?
type III –> immune complexes promote tissue damage through complement activation
