12 years old with ARF

Author: Mikhail Kagan, Turkestanskaya 15a-37, Orenburg, Russia

Question
12 yrs old girl was admitted to our hospital on 3 rd of September {2 weeks ago} with acute renal failure and severe anemia {hemoglobin 6.0 g , dl}. She had been sick for about 1 week before {sore throat}. Creatinine on admission was 280 µmol, l. The erythrocyte sedimentation rate was 70 mm , h. Her urinalysis showed many
RBC , hpf, many WBCs - hpf, proteinuria 2,23 g - l. Anti-streptolysin O titers is 1800 Todd units. C3 complement is low. A renal biopsy was evaluated by light and immunofluorescent
microscopies. By light microscopy the renal biopsy contained 30 very large glomeruli with endocapillary hypercellularity, with considerable infiltration of the glomerulus by neutrophils, with single contoured capillary walls and no segments of sclerosis. 20 {67 percent} has cellular crescents. On Masson`s trichrome stained section the fuchsinophilic subepithelial deposits was seen along the glomerular capillary walls.
There is diffuse severe acute tubular damage with loss of a brush border, degeneration, effacement and desquamation of epithelial cells.
The arteries and arterioles do not show changes. Immunofluorescence show IgG 3plus , C3 3plus, IgM 1plus. She received three pulses of Methylprednisolone 1.0 g daily, followed by oral Prednisolone 60 mg per day. Now Creatinine is 100 µmol , l, hemoglobin 5.2 g , dl. Her blood
pressure is 125 , 80 mmHg. She has moderate edema.

How would you treat this girl_? Is aggressive therapy still

Answer Discussion :

Sangeethaca

continue aggressive therapy , steroids and close monitoring renal parameters, child has RPGN.

15 years ago

khalid ahmed

The picture is suggestive of post streptococcal GN with nephrotic elements, to start with is to treat symptomatically with an eye on electrolyte levels, blood transfusion with the possibilty of dialysis may be needed, to watch for nephrotic elements and if so to treat with prednisolone

15 years ago

View More Comments

12 years old with ARF

Home

Partner Sites