Acute glomerulonephritis mimicking nephrotic syndrome

Abstract

Background: Acute post infectious glomerulonephritis (APIGN) describes a wide range of glomerulonephritis characterized by an immunologic response of the kidney to varieties of infectious agent commonly bacteria. It is characterized by an abrupt onset of haematuria, moderate oedema, hypertension and proteinuria usually < 2g/dl. However, between 2013 and 2015, we managed two children who had histological diagnosis of post infectious glomerulonephritis but presented with full complement of features of nephrotic syndrome including nephrotic range proteinuria in addition to the features of nephritis.

Case reports: A 5year old boy and an 8 year old girl were admitted to our Paediatric Unit with history of generalized body swelling, reduction in the volume of urine and cough. There was no antecedent sorethroat or skin rash. At presentation, both patients had mild dyspnea, anasarca, massive ascitis, and hypertension (130/80mmHg and 150/100mmHg respectively) both systolic and diastolic blood pressure were greater than 99 percentile. Laboratory investigations revealed massive proteinuria of 4+ and 3+ respectively, haematuria, hypoalbuminemia, and hyperlipidemia. The histology of their renal tissues revealed features in keeping with acute glomerulonephritis.

Conclusion: Acute glomerulonephritis may present with features of nephrotic syndrome including nephrotic range proteinuria. Hence in the event of the presentation of a mixed feature of nephrotic-nephritis as obtained in the case of these two children, management should first be in the line of AGN while awaiting the renal hisotology outcome before considering the commencement of steroid.

Keywords: Acute post infectious glomerulonephritis, post streptococcal glomerulonephritis, massive proteinuria