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Originals

Pneumonia-associated acute glomerulonephritis

T. Srivastava, B.A. Warady and U.S. Alon

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Volume 57 (2002) p. 175 - 182

Abstract

T. Srivastava, B.A. Warady and U.S. Alon

Section of Nephrology, The Children?s Mercy Hospital, University of Missouri at Kansas City, Kansas City, USA
Objective: Post-infectious glomerulonephritis typically occurs 7 – 14 days 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. Study design: 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 1 had an interstitial infiltrate. All responded to antibiotic therapy with resolution of fever and respiratory symptoms. Only 1 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 £ 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 anti-hypertensive medications. Only 1
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. Conclusion: 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.

Originals

Random urine calcium/ osmolality in the assessment of calciuria in children with decreased muscle mass

W. Richmond, G. Colgan, S. Simon, M. Stuart-Hilgenfeld, N. Wilson and U.S. Alon

###ENGLISH_ABSTRACT_LINK### ###FREE_ENGLISH_ARTICLE_DOWNLIAD_LINK###

Volume 64 (2005) p. 264 - 270

Abstract

W. Richmond, G. Colgan, S. Simon, M. Stuart-Hilgenfeld, N. Wilson and U.S. Alon

¹Section of Nephrology and ²Department of Medical Research, Children’s Mercy Hospital, University of Missouri, Kansas City, MO, USA
Background: Random urine Ca/creatinine (UCa/Cr) is used to estimate 24-hour Ca excretion. However, due to decreased urine creatinine excretion in children with decreased muscle mass (DMM), UCa/Cr overestimates their Ca excretion. Objective: To evaluate whether in children with DMM random urine Ca/osmolality (UCa/Osm) can accurately predict hypercalciuria (24-hour urine Ca > 4.0 mg/kg) and at which “cutoff” value. Methods: 19 children with DMM and 29 with normal muscle mass (NMM), ages 6 – 17 years, were studied. DMM was diagnosed based on clinical findings and decreased serum creatinine, and confirmed by low urine creatinine excretion. Over 24 hours, subjects collected each void separately. After each sample was analyzed, samples of each participant were combined to form a 24-hour specimen from which an aliquot (AL) was obtained; 24-hour urine Ca was first correlated with the corresponding AL Ca/Cr and Ca/Osm. As an internal control, a similar assessment of proteinuria was conducted. In the next step, AL data were compared with individual urine samples to identify the time of day when a random sample best correlates with AL. Results: The correlation coefficient between 24-hour Ca and AL Ca/Cr in all children was 0.61, in NMM 0.96, and in DMM 0.69 (in all p < 0.001). The correlation coefficient between 24-hour urine Ca and AL Ca/Osm in all children was 0.90, in NMM 0.90, and in DMM 0.91 (in all p < 0.001). In children with DMM, the correlation coefficient of 24-hour protein with AL protein/Cr was 0.75, and with protein/Osm 0.98 (both p < 0.001). Receiver operating characteristic curves showed UCa/Cr as a better predictor of 24-hour Ca > 4.0 mg/kg in NMM, whereas UCa/Osm was a better predictor of hypercalciuria in DMM patients. In NMM, UCa/Cr ratio > 0.20 had sensitivity of 88% and specificity of 96% in detecting 24-hour Ca > 4.0 mg/kg, whereas in those with DMM UCa/Osm (× 10) ratio of > 0.25 had sensitivity of 100% and specificity of 93% in detecting hypercalciuria. It was further found that random urine specimens collected between 9:00 a.m. and 2:00 p.m. best represented 24-hour urine data. Conclusion: In children with DMM, UCa/Osm can successfully replace UCa/Cr as a screening tool for hypercalciuria.Correspondence to:
U.S. Alon, MD
Section of Nephrology
Children’s Mercy Hospital
2401 Gillham Road
Kansas City, MO 64108, USA
Email: [email protected]

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