Systemic complications of acute glomerulonephritis in Nigerian children

This study was undertaken to: (i) determine the prevalence, pattern and outcome of systemic complications of acute glomerulonephritis (AGN), and (ii) evaluate some clinicolaboratory features of the disease in Nigerian children. Clinical and laboratory records of consecutive cases of AGN seen over a period of 3 years in our unit, were prospectively entered into nephrology record forms and later analysed. Some of the analysed data included age, sex, blood pressure, types of systemic complication, haematocrit, plasma electrolytes, urea, creatinine, protein and albumin. Fractional excretion of filtered sodium (FeNa, %) and 24-hours urinary protein concentration data were also analysed. Majority of the patients (18/29) were under 6 years of age, with peak age incidence of 3 years. The hospital incidence of AGN and prevalence of systemic complications were 10 new cases per year and 41.38%, respectively. Heart failure (HF) and acute renal failure (ARF) were sole systemic complications in 7 and 2 AGN patients, respectively. Three patients had double systemic complications: one each of hypertensive encephalopathy (HTE)+HF, HTE+ARF and ARF+HF. Ten of 29 patients (34.48%) had nephrotic range proteinuria. None of the AGN patients except those with ARF had FeNa >1%, plasma bicarbonate <15 mmol/l, urea 225 mmol/l and creatinine 2400 mmol/l. Two of the patients died: one each of ARF and ARF+HF, giving a case fatality and mortality rate of 6.90% and 0.08%, respectively. ARF is clearly the principal risk factor for mortality in our AGN patients. Its early detection and aggressive but purposive management which must include dialysis, will certainly improve outcome in AGN cases complicated by ARF.