الفهرس 
Acknowledgement
Acute post streptococcal glomerulonephritisOnly 14 pages are availabe for public view
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Abstract
The present study included 58 children with APSGN who were admitted to Assiut University Children Hospital over one year period from the 1st of October 2016 to the 30th of September 2017. Their ages were ranged from 3 to 15 years, 59% of cases were males and 41% were females.
The aim of the study is to assess degree of adherence of medical physicians to Assiut University Children Hospital protocol for management of acute poststreptococcal glomerulonephritis according to modified South African guidelines.
Data of the study showed that demographic data were recorded in 100% of cases. Detailed history intake and clinical examination showed minimal defects in taking history as symptoms suggestive of HTN and checking for oliguria.
All cases were asked about history of preceding pharyngitis / tonsillitis or Skin infection 1-3 weeks before disease and 90% of cases were found to have history of preceding pharyngitis / tonsillitis and 10% of cases with history of preceding skin infection.
All cases were asked about oedema, red urine and oliguria . And (12%) of cases were not asked about symptoms suggestive of HTN. The most presenting complaint in our study was haematuria (88%), oedema (69%) and oliguria (20%). History suggestive of HTN was found in only (19%) of cases.
All cases were checked by clinical examination for oedema, haematuria, oliguria and hypertension except for (14%) of cases were not checked for oliguria.
HTN was found in 35 cases (60%) , 24 of them were asymptomatic. But the study showed a defect in putting patients on blood pressure level for age and height percentile . It was not done in all cases.
Investigations were done efficiently for all patients except for ABG and serum Cl.
Urine analysis was done in all patients. Microscopic haematuria was found in (100%) of patients while trace to +2 proteinuria was found in (90%) of patients.
ASOT was done in ( 100%) of cases and it was positive in (100%) of them.
Complement test was done in (100%) of cases and C3 was decreased and C4 was normal in (100%) of cases .
Serum electrolytes (Na and K ) was done in (100%) of cases , hyperkalemia was detected in 7 cases, while serum Na was normal in all cases except one case that it was elevated. Serum chloride was done in only 3 cases in which it was normal.
Urea and creatinine were done in (100%) of cases, elevated serum creatinine was detected in (36%) of cases while urea was elevated in (41%) of cases.
CBC was done in all cases, anemia was found in (97%) of cases while leukocytosis was detected in (7%) of cases and the rest of cases it was normal. ABG was done in (33%) of cases .
The lines of management of APSGN have some defects in the general and supportive measures , as evaluating the fluid status, daily weight, measuring fluid input and output and K restriction in hyperkalemic patients as it makes patients at more risk for complications.
Bed rest was advised in (100% ) of cases, while daily weight was done in (59%) of them. Monitoring fluid intake was done in (66%) of cases and monitoring urine output was done in (86%) of them.
Oliguria was detected in (17%) of cases and all of them were given oral fluid intake to replace insensible water loss + urine output of previous 24 hours. While normal urine output was detected in 69% of cases and all were given normal fluid intake. Urine output was not assessed in 14% of cases .
Na restriction was done in (74%) of cases. But K restriction was not done in all patients including hyperkalemic patients. Protein restriction to 0.5 gm/kg/day was not also done at all in the studied patients.
Amoxicillin +Clavulanic acid were prescribed in proper dose and duration in (90%) of cases.
Furosemide was used as an initial treatment of HTN in 30 cases (86%) . Two of them showed no response and sublingual nifedipine was used . captopril was used in (100%) of cases presented by HTN, six of them were not controlled by captopril alone and oral nifidipine was added.
Monitoring blood pressure every 2-4 hours during the 1st 24 hours was done in 86% of cases while monitoring blood pressure after 24 hours to exclude rebound HTN was done in (100%) of cases.
Advising patients for follow up at outpatient clinic was done in (100%) of cases.
Conclusion
APSGN is still a problematic kidney disease in pediatrics.
Evaluation of the studied patients were done perfectly except for some defects in history taking for HTN and examination for oliguria, some laboratory investigations with less importance in diagnosis.
Management was perfectly done except for general and supportive measures.
Recommendations
To improve the outcome of management of APSGN we recommend:
1) Proper history taking from the patient parents or relatives with proper documentation in the patients files.
2) Follow the examination sheet and write daily progressive notes of the patients.
3) Stress on general and supportive measures including weighting patients daily, calculating fluid input and output and checking patients for oliguria, and follow up proper dietary measures especially for HTN and hyperkalemic patients .
4) Stress in putting patients on blood pressure level of age and height percentile for accurate detection of HTN.
5) Improve the facilities for investigations for all patients.
6) Strictly follow the guidelines in the diagnosis of APSGN and strictly follow the guidelines in the starting of treatment.