1. Acute poststreptococcal glomerulonephritis
    1. Introduction: Acute poststreptococcal glomerulonephritis (APSGN) is a bilateral inflammation of the glomeruli of the kidneys and is the most common noninfectious renal disease of childhood. It occurs most frequently in early schoolage children, with a peak age of onset of 6-7 years; it is twice as common in boys as in girls. Like rheumatic fever, acute glomerulonephritis is thought to be the result of an antigen-antibody reaction to a streptococcus infection; however, unlike rheumatic fever, it does not tend to recur, because specific immunity is conferred following the first episode of APSGN.
    2. Assessment:
      1. Typical concerns from family about urine: change in color/appearance of urine (thick, reddish brown; decreased amounts).
      2. Acute edematous phase-usually lasts 4-10 days.
        1. Lab examination of urine:
          1. Severe hematuria.
          2. Mild proteinuria.
          3. Increased specific gravity.
        2. Hypertension
          1. Headache.
          2. Potential hypertensive encephalopathy leading to seizures, increased intracranial pressure.
        3. Mild-moderate edema: chiefly periorbital; increased weight due to fluid retention.
        4. General:
          1. Abdominal pain.
          2. Malaise.
          3. Anorexia.
          4. Vomiting.
          5. Pallor.
          6. Irritability.

Comparison of Nephrosis and Acute Poststreptococcal Glomerulonephritis

Factor Nephrosis (Nephrotic Syndrome) Acute Poststreptococcal Glomerulonephritis (APSGN)
Illness type Chronic Acute
Illness course Characterized by periods of exacerbations and remissions during many years Predictable, self-limiting, typically lasting 4-10 days (acute edematous phase)
Cause Unknown Group A (3-hemolytic streptococci
Age at onset 2-4 years Early school-age children; peaks at 6-7 years
Sex More common among boys More common among boys
Major signs and symptoms:
General Syndrome with variable pathology, massive proteinuria, hypoalbuminemia, severe edema, hyperlipidemia Hematuria, hypertension
Blood pressure Normal or decreased Elevated
Edema Generalized and severe Periorbital and peripheral
Proteinuria Massive Moderate
Serum protein level Decreased (6.1-7.9 g/dL) Increased
Serum lipid level Elevated Normal
Potassium level Normal (3.5-5 mEq/L) Increased
Treatment Symptomatic—no known cure; prednisone, cyclophosphamide, furosemide Penicillin (EES), hydralazine, furosemide
Diet Decrease sodium, increase protein Decrease sodium, decrease potassium, increase protein
Fluid restrictions Seldom necessary Necessary if output is significantly reduced
Specific nursing care Treat at home if possible; good skin care; prevent infection Treat in hospital during acute phase; monitor vital signs, especially blood pressure; on discharge, stress need to restrict activity until microscopic hematuria is gone
Prognosis Fair; subject to long-term steroid treatment and social isolation related to frequent hospitalizations/confinement during relapses; 20% suffer chronic renal failure Good; stress that recurrence is rare because specific immunity is conferred