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Nephrology, including fluid and electrolytes
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Less than 5% of children with post-streptococcal glomerulonephritis develop chronic renal failure. Complications of acute glomerulonephritis include renal failure, cardiac failure, hypertension and hypertensive encephalopathy. Of the many markers of streptococcal infection, ASO titre is the most useful. Life-long penicillin prophylaxis is not recommended as second attacks of acute glomerulonephritis are rare. Serum complement levels are low only during the acute phase and return to normal within 3 months after the onset of the disease.
Acquired Bleeding Disorders Associated with Disease and Medications
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
William A. Rock, Sue D. Walker
a. Acute Glomerulonephritis. In acute renal failure such as acute glomerulonephritis, the clotting system is not usually affected directly by the disease. Blood loss via the kidneys can be extensive, but is not a reflection of an altered coagulation status (59). In acute glomerulonephritis, thrombocytopenia may occur as a result of shortened platelet survival, and antiplatelet therapy may actually reduce the thrombocytopenia (60,61); however, bleeding due to an intrinsic alteration in the plasma clotting system is not usually seen. Other complicating diseases such as sepsis or DIC may complicate the clinical presentation. Acute renal failure can become chronic renal failure resulting in significant bleeding risk; see below (62,63).
Skin infections
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
In tropical and subtropical areas, an impetigo-like disorder is spread by flies and biting arthropods. This disorder is more destructive than ordinary impetigo and produces deeper, oozing and crusted sores and is caused mostly by beta-haemolytic streptococci. It is sometimes known as ecthyma. There have been several outbreaks of acute glomerulonephritis following episodes of this infective disorder.
Concomitant rapidly progressive glomerulonephritis and acute rheumatic fever after streptococcus infection: a case report
Published in Paediatrics and International Child Health, 2022
Suwanna Pornrattanarungsi, Sudarat Eursiriwan, Yupaporn Amornchaicharoensuk, Chutima Chavanisakun, Ornatcha Sirimongkolchaiyakul
Acute post-streptococcal glomerulonephritis (APSGN) and acute rheumatic fever (ARF) are common, non-suppurative disorders which occur after group A streptococcal (GAS) infection, especially acute pharyngitis or skin infection [1,2]. Typical clinical manifestations in acute glomerulonephritis are hypertension, oedema and glomerular haematuria. Acute rheumatic fever may be associated with cardiac lesions together with systemic signs and symptoms such as polyarthritis, chorea, erythema marginatum, fever and increased inflammatory markers. The diagnosis of APSGN or ARF requires laboratory evidence of preceding streptococcal infection. However, the main mechanism underlying both diseases varies. Immune complex formation is the crucial pathogenesis of APSGN whilst ARF can arise as a result of molecular mimicry [3]. Rarely, however, both occur simultaneously.
Organisation and quality monitoring for point-of-care testing (POCT) in Belgium: proposal for an expansion of the legal framework for POCT into primary health care
Published in Acta Clinica Belgica, 2022
Viviane Van Hoof, Dragos Barglazan, Laurent Blairon, Bob Braekevelt, Regis Debois, Nathalie Véronique J. De Vos, Damien Gruson, Jef Jonckheere, Katrien Lanckmans, Marc Moens, Bart Peeters, Joris Penders, Alain Roman, Lieve Van Hoovels, Florent Vanstapel, Jan Y. Verbakel, Ann Verdonck, Alain G. Verstraete
Group A streptococcus (Streptococcus pyogenes, group A beta-haemolytic streptococcus, GAS) infection causes acute pharyngitis. If untreated, this can lead to serious complications such as acute glomerulonephritis (kidney inflammation) and acute rheumatic fever. Antibiotics are very effective in treatment of GAS. As acute pharyngitis may be caused by other bacterial infections or viral infections, some clinical guidelines recommend that antibiotics should only be used in proven GAS infections [27]. Nevertheless about 60% of patients with a sore throat are prescribed antibiotics, while GAS is the cause of the pharyngitis in only 5–30% of the cases. A recent study has shown that in real-world circumstances RADT results and laboratory cultures were less specific and sensitive than the literature has suggested, which has led to inappropriate antibiotic use. POCT based on NAATs (nucleic acid amplification techniques) on the other hand combines high sensitivity and specificity resulting in more efficient use of antibiotics in primary care settings in a US study [28]. However, like RADTs and throat culture, NAATs cannot by themselves discriminate between an infection and a carrier state. Therefore, they must be supplemented with a physical examination to avoid negatively affecting antimicrobial stewardship efforts [29].
Acute renal failure with need for renal replacement therapy as a complication of zoonotic S. zooepidemicus infection: case report and review of the literature
Published in Acta Clinica Belgica, 2018
Laurens Veldeman, Katrien De Wilde, Dirk Vogelaers, Evelyne Lerut, An Vonck, Dien Mertens, Annelies Koch, Jan Beckers
There are similarities as well as differences in clinical and biochemical presentation of PSGN in adults and children. Both age groups present with a symptomatic acute glomerulonephritis syndrome. More than a quarter of patients have arterial hypertension, most likely due to salt and water retention. Peripheral edema is present in two-thirds of patients,8 macroscopic hematuria with dysmorphic red and white blood cells and – casts in 17–56 % of patients. Proteinuria is mostly present, however in different levels, fitting criteria of nephrotic range proteinuria (>3.5 g /24 h) in a quarter to a third of adults, whereas in children this is rather exceptional.1,4,9,10 Hypocomplementemia is present in 35–80% of adults and in 90% of children. Most cases present with low C3 without decrease in C4 levels.1,4 Decrease in renal function (eGFR <90 ml/min/1.73 m2) is noted in 20% of children during the acute disease episode; however, RRT is rarely needed. Occasionally, a child develops crescentic glomerulonephritis (GN) with rapidly progressive renal dysfunction. In adults almost half of the patients need RRT, mostly for fluid overload and uremic symptoms.1,4,9,10