الفهرس 
Acknowledgement
Intrarenal arteriesOnly 14 pages are availabe for public view
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Abstract
APSGN is really a disease of childhood that accounts for approximately 90% of renal illnesses in children. It is an immunologic response of the kidney to infection, characterized by sudden appearance of edema, hematuria, proteinuria, and hypertension. The disease occurs mainly in children between the ages of 2 and 12 years, and more often in male than in female. The commonest infective agent in children that causes the widest range of clinical disease in humans is group A beta-hemolytic streptococcus (GABHS) and follow upper airway infections such as pharyngitis or tonsillitis by 14 to 21 days in countries with moderate and cold climates during the winter months and 3-6 weeks after skin infection especially in warmer climates. Typically the disease has seasonal character, but isolated cases may be seen throughout the whole year and in some areas, epidemics appear cyclically every 5–7 years; there is no satisfactory explanation for this phenomenon. The quantity of patients with PSGN had decreased significantly in the industrialized countries, while in some developing communities of the world, the incidence of PSGN had remained high. APSGN is one of the leading cause requiring hospital admissions in children and it is also an important cause of acute renal failure in developing countries. Though deaths due to this disease are extremely rare, it can cause serious complications such as rapidly progressive glomerulonephritis, hypertensive emergency, hypertensive encephalopathy and congestive heart failure. This clinical prospective descriptive study of APSGN in childern, which was conducted at AUCH during the period between 1st of May to 30th April 2018. The study included 70 patients with symptoms and signs suggesting APSGN diagnosis The aim of this work is to study the clinical presenttion, diagnosis, complications and outcome of APSGN in children as well as to follow-up patients with lower serum complement system (C3) from the start of the disease and after 6-8 weeks This study included 70 children patients, their age ranged from 2-15 years old with ± SD (7.7± 3.2). Males were affected more than females (57.1% vs 42.9%) As regard seasonal incidence variation of APSGN, we noticed that, the disease was more common in winter (41.4%) and spring (30%) than in summer (27.1%) and autumn (1.4%). Results of the present study showed that, 90% of cases had history of preceding pharyngitis/tonsillitis and 10% of cases had history of preceding skin infection caused by group A beta hemolytic streptococci. The incidence of APSGN disease was high among population with low socioeconomic standard (61.4%) compared to that with medium (30%) and high standard level (8.6%). This could be attributed to poverty, ignorance, over crowdedness, bad housing and poor hygiene.Hematuria was the most common clinical finding that occurred in 58 cases (82.9% of patients), while edema was found in 54 cases (77.1% of patients) In the present study, 29 patients (41.4%) had normal blood pressure, while 41 patients (58.6%) complained of different stages of HTN with history of anxiety in 9 cases (12.9%), headache in 14 cases (20%), bleeding per nose in 5 cases (7.1%), convulsions in 8 cases (11.4%), and disturbed conscious level in 3 cases (4.2%). We noticed that, of the 41 patients with HTN, 4 cases (5.7%) had prehypertension (90th-95th percentile), 20 cases (28.6%) had stage Ι HTN (95th-99th percentile plus 5 mmHg) and 17 cases (24.2%) of them had stage ΙΙ HTN (>99th percentile plus 5mmHg Regarding laboratory investigation, the present study was supported by the easiest and basic tests to confirm the diagnosis of APSGN. By urine dipstick we found that, 35 cases (50% of patients) had hematuria (+1 to +3), 7 cases (10% of patients) had proteinuria (trace to +2) and 28 cases (40% of patients) had both hematuria and proteinuria. Macroscopic and microscopic examination of urine showed that, 13 cases (18.6% of patients) had microscopic RBCs, 4 cases (5.7% of patients) had microscopic RBCs and granular casts, 22 cases (31.4% of patients) had microscopic RBCs and albumin, while 31 cases (44.3% of patients) had smoky urine, RBCs and granular casts and albumin. Dilutional anemia was found in 47 cases (67.1% of patients). Thrombocytopenia occurred in 4 cases (5.7% of patients) and 5 cases (7.1% of patients) had thrombocytosis. Lecocytosis was found in 26 cases (37.1% of patients) and one case (1.4 % of patients) had leucopenia. Serum biochemistry’s were done for all cases of this study and showed no significant changes in most cases. Serum sodium and potassium were normal in 65 cases (92.9% of patients) and 63 cases (90% of patients) respectively. Hyponatremia occurred in 2 cases (2.9% of patients) only, but hypernatremia was found in 3 cases (4.3% of patients). We noticed hyperkalemia in 5 cases (7.1% of patients) and hypokalemia in 2 cases (2.9% of patients) only. BUN was normal in 45 cases (63.4% of patients) and elevated in 25 cases (35.7% of patients) only. Serum creatinine level was normal in 47 cases (67.1% of patients) and elevated in 23 cases (32.9% of patients).ASOT was positive in 69 cases (98.6% of patients) while, regarding the most constant and important serological test we noticed that, serum C3 levels decreased in 67 cases (95.7% of patients) and normalized after 6-8 weeks in all patients. Hypo-albuminemia was found in 5 cases with APSGN only (7.1% of patients), but 65 cases (92.9% of patients) had normal serum albumin. The 24hr protein excretion in urine was normal (<150 mg/24 hours urine) in 68 cases (97.1% of patients) and proteinuria (>150 mg/24 hours urine) occurred in 2 cases only (2.9% of patients), but it was mild and did not reach the nephrotic range. Complication of APSGN occurred with the highest frequency of 7.14% of all studied patients who had RPGN, with good outcome in the majority of cases. Hypertensive encephalopathy was the second most common complication occurred in 3 cases (4.3% of patients), but hypertensive emergency was recorded in 2 cases (2.9% of patients) also, we found that only 2 cases (2.9% of patients) had congestive heart failure. The prognosis and outcome of APSGN was excellent and full recovery occurred in 58 cases (82.9% of patients) and there was no deaths. from the result and data of our present study we can conclude that: 1- APSGN is a disease of a childhood. 2- Despite global decline of APSGN, still it represents a health problem in less wealthy nation. 3- Cases of APSGN found throughout the whole year with, a characteristic seasonal variation. 4- Upper respiratory tract and skin infections are a preceding causes of APSGN due to infection by group a beta-haemolytic streptococci. 5- Males are more affected than females. 6- Prompt address on clinical presentation, diagnosis and complications are the main stay of treatment. 7- Haematuria is the main cause for seeking medical advice. 8- ASOT is perfect for detecting APSGN9- Serum complement system (C3) is the corner stone for diagnosis of APSGN. 10- Follow-up of serum complement system (C3) level after 6-8 weeks made the disease easier. 11- RPGN, hypertensive emergency, hypertensive encephalopathy and congestive heart failure are a serious complications of APSGN if poverty and negligence prevent early prompet treatment. 12- Short-term outcome of APSGN is excellent at expert hand. 13- Recurrence of APSGN is very rare.