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Abstract
APSGN is an acute reversible disease characterized by spontaneous recovery in the vast majority of patients (95%). It is by far the most common form of glomerulonephritis in children.
Diagnostic features of APSGN include:
A clinically compatible illness, usually with the classical acute nephritic syndrome representing as hematuria, edema, hypertension and / or oliguria, and all three of the following: (74)
1. Dysmorphic RBCs, Acanthocytes ± RBC casts.
2. Reduced serum C3 level < 80mg/dl
3. Evidance of recent group A streptococcal infection, either:
a- A positive throat or skin culture.
b- Elevated ASOT > 200 IU/mL..
c- Elevated anti DNase B> 300U/. mL.
In this study cases with APSGN were 35 male (70%) and 15 female (30%) with a male /female ratio of 2.3:1. Their age ranged from (3- 12) years with a mean age 6.4±2.56 years. The larger population size was within age group (3<6) years.
Data from our study showed that APSGN in children attending AUCH is mainly pharyngitis – associated. History of throat infection could be established in 100% of cases of APSGN. None of the study children had antecedent skin infection.
Our study conducted on 50 cases attending AUCH showed that the clinical presentations were gross hematuria & proteinuria in 100% of cases, oedema in 66%, and hypertension in 44%, oliguria in 14%, ARF in 2 cases (4%), hypertensive encephalopathy in one case ( 2%) with seizures, confusion and coma. While hematuria alone occurred in 22% of cases, the classical nephritic triad (hematutia, hypertension and edema) in 14% of cases. While hemturia, hypertension, edema & oliguria in 6% of cases.
Also as regards urinary changes in children with APSGN; all cases present by hematuria, proteinuria which range from +1(10%) ,+2(62%), +3(28%), granular casts, red cell casts in 50% of cases, dysmorphic RBCs ≥25% with acanthocytes ≥ 5% . 24hrs protein divided into non-nephrotic range in 92%& nephrotic range in 8% of cases. 6% of children presented by complication: Acute renal failure in 4% of cases, hypertensive encephalopathy in 2% of cases but no congestive heart failure among the studied group.
As regards general investigation among our study sample; Ht SDS was normal in 100% of cases, puffy eyelids in 60% of cases, fever in 12% of cases abdominal pain and vomiting in 8% of cases.
It was found that elevation of BUN in 52% of cases , s.creatinine in 40 % of cases and elevation of ASOT in 100% of cases. While low serum C3 level in 100% of cases.
In our study: All cases presented by hematuria, proteinuria, granular casts and dysmorphic RBCs with acanthocytes. RBCs in urine ranged from 50-100 rbcs / HPF with a mean 86.82±17.65 and red cell casts presented in 50% of cases. 24hrs protein ranged from 150-2800 mg/24hrs with a mean of 457.58±514.6 & divided into non - nephrotic range in 92% and nephrotic range proteinuria in 8% of cases. dysmorphic RBCs in urine ranged from 25%-70% with a mean of 39.62± 9.15 and urinary acanthocytes ranged from 5% -10% with a mean 6.52±1.39.
As regard renal ultrasonographic changes among our study showed that it was normal in about 32% of cases and increased corticol echogenicity with normal corticomedullay differentiation in 68%.
Our study showed that resolution of the clinical presentations of cases with APSGN was quite rapid, Blood pressure returned to normal within 1- 4, edema returned within 1-2 weeks, gross hematuria returned within 1-2 weeks, cases with low serum C3 returned to normal within 4-6 weaks, BUN returned within 1-6 weeks, seum creatinine returned within 1-6 weeks, microscopic hematuria returned to normal within 4-6 weeks and gross hematuria within 1-2 weeks.
Much attention is now being paid to the development of streptococcal group A vaccine and studies have already been performed on its preparation, safety and efficacy