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Pneumonia-associated acute glomerulonephritis
T Srivastava1, Warady, U S Alon
1Section of Nephrology, The Children's Mercy Hospital, University of Missouri at Kansas City 61408, USA.
Insights
Pneumonia in children can sometimes coincide with acute glomerulonephritis (AGN), a kidney inflammation. Most cases of pneumonia-associated AGN resolve well, but some children may need medical intervention for kidney issues.
Area of Science:
- Pediatric Nephrology
- Pediatric Pulmonology
- Infectious Diseases
Background:
- Post-infectious glomerulonephritis (PIGN) typically manifests 7-14 days post-infection.
- Acute glomerulonephritis (AGN) has been observed to occur concurrently with pneumonia in some pediatric cases.
- The clinical course and outcomes of pneumonia-associated AGN require further delineation.
Purpose of the Study:
- To investigate the clinical presentation and prognosis of children experiencing acute glomerulonephritis (AGN) concurrently with pneumonia.
- To identify key indicators for evaluating children with pneumonia for concomitant glomerulonephritis.
Main Methods:
- Retrospective review of hospital records from 1984-1999.
- Inclusion criteria: children admitted with both acute pneumonia and AGN diagnosed within 72 hours of each other.
- Analysis of clinical data, laboratory results, urinalysis, and treatment outcomes.
Main Results:
- Eleven boys (age 3.8-12.7 years) with pneumonia-associated AGN were identified.
- All patients received antibiotics for pneumonia; most showed resolution of respiratory symptoms.
- Abnormal urinalysis (hematuria, proteinuria, casts), elevated creatinine, low complement C3, and elevated ASO titers were common.
- Hypertension and azotemia were observed in several children; most normalized with follow-up.
- One child required dialysis for severe oliguria; kidney biopsy revealed acute proliferative glomerulonephritis.
Conclusions:
- Children with pneumonia presenting with abnormal urinalysis, hypertension, azotemia, or oliguria should be assessed for concurrent glomerulonephritis.
- Pneumonia-associated AGN generally follows a benign course with a favorable prognosis in most pediatric cases.
- Short-term medical interventions may be necessary for some children with pneumonia-associated AGN.
Objective:
Post-infectious glomerulonephritis typically occurs 7-14days after an infection. However, in several children we observed acute glomerulonephritis (AGN) to develop concurrently with pneumonia. The objective of the study was to delineate the clinical course and outcome of pneumonia-associated AGN.
Study Design:
The hospital database was searched from 1984 - 1999 for c+hildren admitted with both acute pneumonia and AGN, each diagnosis having been made within 72 hours of each other.
Results:
11 boys, age 3.8- 12.7 years, were identified. Ten children had lobar pneumonia and I had an interstitial infiltrate. All responded to antibiotic therapy with resolution of fever and respiratory symptoms. Only I child developed an empyema. The mean +/- SD hospital stay was 5.9 +/- 3.9 days. All patients had an abnormal urinalysis with hematuria (gross hematuria in 5), proteinuria and cellular casts. At presentation, 7 children had a serum creatinine > 1.0 mg/dl and creatinine clearance < or = 80 ml/min/1.73 m2; in all, serum creatinine returned to normal and the creatinine clearance was > 80 ml! min/1.73 m2 on follow-up. Nine of the 11 children had a low serum complement C3, 3 of whom also had low complement C4. Anti-streptolysin-O (ASO) titers were elevated in all 10 children tested. Six children developed hypertension and received antihypertensive medications. Only I child was severely oliguric requiring peritoneal dialysis for 4 days. He underwent a kidney biopsy, which showed acute proliferative glomerulonephritis without crescents. Neither a biopsy nor dialysis was performed in the other children. At follow-up, blood pressure, urinalysis and serum complements had normalized in the 9 children in whom follow-up was available.
Conclusion:
Children with pneumonia who are found to have abnormal urinalysis. hypertension, azotemia or oliguria should be evaluated for concomitant glomerulonephritis. In most children, pneumonia-associated AGN runs a benign course and has a good prognosis, however, in some short-term medical intervention may be necessary.