CLINICAL CASE7 URINARY SYSTENM A 10-year-old male presents with his several epis
ID: 3481331 • Letter: C
Question
CLINICAL CASE7 URINARY SYSTENM A 10-year-old male presents with his several episodes of red-brown urine but otherwise has no complaints. At a but his past medical history is otherwise unremarkable. He takes no medications. On review of systems, he mother, who appears very anxious. She reports this morning. The patient reports feeling a bit tired, ge 5, he had myringotomy tubes placed bilaterally, reports a sore throat that completely resolved a few days ago. On exam you find a pleasant young man in no acute distress. He is afebrile. His blood pressure is 140/94 mm Hg, and he has trace pretibial edema. The remainder of the exam is unrevealing. Urinalysis shows 2+ blood, 2+ protein, specific gravity 1.015, and numerous red blood cells with red cell casts. BUN is 35 mg/dL and creatinine is 1.8 mg/dL. CBC (Complete Blood Count), coagulation studies, and electrolytes are all normal. Throat culture grows group A beta-hemolytic streptococcus. Questions: 1. What do you think is going on? 2. What is the causative agent of this disorder? 3. Which best describes the usual course of post-streptococcal glomerulonephritis? 4. Which are the signs and symptoms of this disease? Is this case a typical one? 5. What is the mechanism of this disease? 6. What is the course of the disease and compare adult vs. Children.Explanation / Answer
1. The glomeruli are affected due to deposition of streptococcal antigen-antibody complexes.
2. The causative agent is group A beta hemolytic streptococci.
3. Manifestations of acute glomerulonephritis like sudden development of malaise, fever, nausea, hematuria following an attack of sore throat or skin infection in a child with usually complete excellent prognosis.
4. Signs and symptoms include
moderate proteinuria, haematuria, oliguria, oedema, anaemia, leucocytosis . The case is typical of post-streptococcall glomerulonephritis since the patient is a young male with features of acute glomerulonephritis with recent history of sore throat. The only atypical feature is presence of hypertension.
5. There is in-situ production of streptococcal antigen-antibody complexes which get deposited in the glomeruli. Granular deposits on the glomeruli can be seen which are indicative of immune-mediated pathogenesis.
6. The normal course in children is development of manifestations of acute glomerulonephritis with spontaneous recovery in majority of them with conservative therapy aimed at maintaining sodium water balance.
The course in adults is atypical and about 40% of patients develop persistent hematuria, hypertension and proteinuria.