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A Pediatric Case of Diffuse Alveolar Hemorrhage Secondary to Poststreptococcal Glomerulonephritis

Alison Markland1, Gregory Hansen2, Anke Banks3

  • 1University of Saskatchewan, Saskatoon, SK, Canada.

Case Reports in Critical Care
|February 10, 2018
PubMed

Insights

This case report highlights a rare presentation of poststreptococcal glomerulonephritis with diffuse alveolar hemorrhage in a child. Continuous renal replacement therapy (CRRT) may have facilitated recovery by removing harmful circulating factors.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Rheumatology

Background:

  • Poststreptococcal glomerulonephritis (PSGN) is a common post-infectious kidney disease in children.
  • Diffuse alveolar hemorrhage (DAH) is a rare but severe complication, particularly in younger children.
  • The pulmonary-renal link in PSGN-associated DAH is not fully understood.

Observation:

  • A 4-year-old girl presented with PSGN and DAH, an unusual clinical manifestation.
  • The patient exhibited rapid clinical improvement following treatment.
  • Continuous renal replacement therapy (CRRT) was initiated as part of her management.

Findings:

  • CRRT may have played a crucial role in the patient's recovery.
  • The proposed mechanism involves the removal of circulating factors like immune complexes, endothelial microparticles, and superantigens.
  • These factors are implicated in the pulmonary-renal syndrome observed in this condition.

Implications:

  • This case suggests CRRT as a potential therapeutic strategy for PSGN with DAH.
  • Further research into the efficacy of CRRT in similar pediatric cases is warranted.
  • Exploring the removal of specific pathogenic factors by CRRT could elucidate treatment mechanisms.

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