Pneumonia-associated acute glomerulonephritis.
OBJECTIVE
Post-infectious glomerulonephritis typically occurs 7-14days after an infection. However, in several children we observed acute glomerulonephritis (AGN) to develop concurrently with pneumonia. The objective of the study was to delineate the clinical course and outcome of pneumonia-associated AGN.


METHODS
The hospital database was searched from 1984 - 1999 for c+hildren admitted with both acute pneumonia and AGN, each diagnosis having been made within 72 hours of each other.


RESULTS
11 boys, age 3.8- 12.7 years, were identified. Ten children had lobar pneumonia and I had an interstitial infiltrate. All responded to antibiotic therapy with resolution of fever and respiratory symptoms. Only I child developed an empyema. The mean +/- SD hospital stay was 5.9 +/- 3.9 days. All patients had an abnormal urinalysis with hematuria (gross hematuria in 5), proteinuria and cellular casts. At presentation, 7 children had a serum creatinine > 1.0 mg/dl and creatinine clearance < or = 80 ml/min/1.73 m2; in all, serum creatinine returned to normal and the creatinine clearance was > 80 ml! min/1.73 m2 on follow-up. Nine of the 11 children had a low serum complement C3, 3 of whom also had low complement C4. Anti-streptolysin-O (ASO) titers were elevated in all 10 children tested. Six children developed hypertension and received antihypertensive medications. Only I child was severely oliguric requiring peritoneal dialysis for 4 days. He underwent a kidney biopsy, which showed acute proliferative glomerulonephritis without crescents. Neither a biopsy nor dialysis was performed in the other children. At follow-up, blood pressure, urinalysis and serum complements had normalized in the 9 children in whom follow-up was available.


CONCLUSIONS
Children with pneumonia who are found to have abnormal urinalysis. hypertension, azotemia or oliguria should be evaluated for concomitant glomerulonephritis. In most children, pneumonia-associated AGN runs a benign course and has a good prognosis, however, in some short-term medical intervention may be necessary.
Srivastava
T
T
Section of Nephrology, The Children's Mercy Hospital, University of Missouri at Kansas City 61408, USA.
Warady
Alon
U S
US
D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D003176:Complement C3 / Q000032:analysis; D003404:Creatinine / Q000097:blood; D005921:Glomerulonephritis / Q000097:blood / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000648:ultrastructure*; D007902:Length of Stay; D008297:Male; D011014:Pneumonia / Q000150:complications*
D003176:Complement C3; D003404:Creatinine