When are specialist consultations indicated for the treatment of acute poststreptococcal glomerulonephritis (APSGN)?

Updated: Dec 05, 2018
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Answer

The general pediatrician should be capable of treating patients with mild to moderate acute glomerulonephritis. Consultation with a pediatric nephrologist is necessary when 1 or more of the following are present:

  • Severe hypertension

  • Severe oliguria

  • Severe edema

  • Nephrotic-range proteinuria

  • Azotemia (moderate to marked)

  • Recurrent episodes of gross hematuria

  • Persistently depressed C3 (past 8-10 wk)

For failure of expected resolution of clinical signs, consultation is indicated for the following:

  • Gross hematuria within the preceding 10-14 days

  • Microscopic hematuria within 1 year

  • Edema within 2 weeks

  • Proteinuria (>50 mg/dL) within 6 months

  • Azotemia within 1 week

  • Hypertension within 6 weeks


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