Question

A 12 year old boy has a headache, malaise, and poor appetite. He complains of back pain. His mother notices that his face is puffy, especially around the eyes. She becomes alarmed when her son passes smoky-colored urine and immediately brings him in the clinic.

Patient’s history reveals that ten days ago, he had a bad sore throat, fever, and upper respiratory infection and missed several days of school. Physical examination reveals an inflamed pharynx, elevated blood pressure (145/100 mm Hg), abdominal distention, and swollen ankles. His height is 4 feet, 8 inches (1.42m) and his weight is 91 lb (41 kg). Blood urea nitrogen (BUN) concentration is 30 mg/dl (normal 7-18 mg/dl) and plasma creatinine concentration is 2.0 mg/dl (normal 0.8-1.3 mg/dl). A 24-hour urine sample was collected and had a volume of 900 ml and contained 1.30 g creatinine and 0.90 g protein. Microscopic examination of the urine sediment revealed odd-shaped red cells, red cell casts, and leukocytes.

A tentative diagnosis of post-streptococcal glomerulonephritis was made and was later supported by the finding of antibodies against streptococcal exotoxins in the patient’s serum. Certain strains of streptococci provoke an immunological response that damages the kidney’s glomeruli. Treatment with penicillin, diuretic drug, a reduced salt intake, and rest at home were prescribed.

The urine output increased immediately after treatment, and the puffiness in the face and hypertension promptly disappeared. The urine color became normal in a few days, but the urine tested positive for red cells and protein for several weeks. Laboratory values indicated normal renal function one year after this episode.

1. What is the rationale for the treatment given and what are the expected outcomes?
2. How long did it take for the repair of the glomeruli to be complete?

Answer 1

The rationale of the treatment are

• Antibiotics penicillin to treat the infection (because in these types of infection the bacteria affects glomerulus and can cause symptoms weeks after being treated for other site infections)
• Diuretic drugs enables to remove the fluid retention along with this the sodium retention is corrected leading to decrease in facial swelling and reducing blood pressure simultaneously.
• The less salt intake decreases the sodium retention and decreases the blood pressure

Usually if the nephroms once affected cannot be repaired but loss 9f kidney functions can be gained in weeks. In this patient it took nearly a year to completely recover (complete recovery means absence of RBC,protein ,casts in the urine)