DOCTOR'S HOUSE CALL

"Glomerulonephritis" - February, 2005


Dr. James Reilly is a board certified pediatrician practicing on Long Island New York. He attended New York University for his undergraduate training. His medical degree was obtained at The SUNY HSC @ Brooklyn. He went on to do his pediatric residency at Albert Einstein at Montefiore where he was also Chief Resident. While there he was a part of an exchange program with Beijing Childrens' Hospital in China. Touring the nursery filled with unwanted female children helped to spark his interest in international adoption.

Over the years Dr. Reilly has worked with many children adopted from overseas and has a special interest in this area. These areas include Central America, Colombia and China.

Adoptiondoctors.com is an innovative International Adoption Private Practice dedicated to helping parents with the complex pre-adoption medical issues. All medical interactions are performed via, e-mail, express mail, telephone and fax. There is no need to make a live appointment or travel outside of you hometown. For families that live in Long Island New York, Post-Adoption general care can be performed by Dr. George Rogu or Dr. James Reilly in their Adoption friendly, Private Medical practice.
For more info: visit www.adoptiondoctors.com or call them at 631-499-4114.

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I have a video and medical on a 10 year old little girl from Russia. She appears very normal and healthy.Her medical history says she has had streptodermia and acute glomerulonephritis (hematuria type). Chronic glomerulonephritis in remission. What is this medical problem?

Glomerulonephritis is both a generic term for several diseases and a histopathologic term signifying inflammation of the glomerular capillaries in the kidney. Outbreaks are known where "nephritis" strains of group A strep germs are circulating in the blood stream, it is usually is sporadic.

Since there are many different forms of glomerulonephritis there are many different ways it can present. Post streptococcal glomerulonephritis usually presents after an illness with the strep germ either through strep throat or classically from a skin infection such as impetigo. It is most common in children aged 5-12 yr and uncommon before the age of 3 yr. The typical patient develops an acute nephritic syndrome 1-2 wk after an antecedent streptococcal pharyngitis or 3-6 wk after a streptococcal pyoderma, or skin infection.

The patient usually can present with coca cola colored urine or it can be found incidentally on examination of the urine. There can be increases in blood pressure if the kidneys are significantly damaged along with edema (swelling of the extremities).

Urinalysis demonstrates red blood cells, RBC casts, proteinuria, and polymorphonuclear leukocytes. Anemia may be present from low-grade hemolysis and retention of fluid. The serum C3 level is usually decreased in the acute phase and returns to normal 6-8 wk after onset.

A positive throat culture report may support the diagnosis or may simply represent the carrier state. The best single antibody titer to document cutaneous streptococcal infection is the deoxyribonuclease (DNase) B antigen. An ASLO may be done but it notoriously does not rise after skin infections with strep.

The diagnosis of poststreptococcal glomerulonephritis is quite likely in a child presenting with acute nephritic picture, evidence of recent streptococcal infection, and a low C3 level. It is important to consider other diagnoses however.

Treatment of the infection which caused the post streptococcal glomerulonephritis is done first, and then treatment is supportive. Management is directed at treating the acute effects of renal insufficiency and hypertension .A 10-day course of systemic antibiotic therapy with penicillin is recommended. However it does not affect the natural history of glomerulonephritis. The acute phase generally resolves within 6-8 wk. Although urinary protein excretion and hypertension usually normalize by 4-6 wk after onset, persistent microscopic hematuria may persist for 1-2 yr after the initial presentation.

Complete recovery occurs in more than 95% of children with acute poststreptococcal glomerulonephritis. Mortality in the acute stage can be avoided by appropriate management of acute renal failure, cardiac failure, and hypertension.

Infrequently, the acute phase may be severe. However, the diagnosis of acute poststreptococcal glomerulonephritis must be questioned in patients with chronic renal dysfunction because other diagnoses such as membranoproliferative glomerulonephritis may be present. Recurrences are extremely rare.

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Addendum: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical exam can a medical diagnosis and treatment plan be made.

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