Lab Case 35 – Interpretation

1. Describe and Interpret

8 year old girl with oedema and dark urine presents with:

renal failure – Urea 12.1, Creat 101

evidence of infection – WCC 16, N 12.6

haematuria and pyruria on urinalysis – leucs>100, RBC>100

likely cause – Acute Post streptococcal Glomerulonephritis

Caused by Group A Streptococci secondary to skin or throat infection

Other DDx – UTI with dehydration, HUS, Nephrotic Syndrome(less likely)

Second case in 3 days – consider community outbreak

2. Case Definition

Lab evidence – renal biopsy

or

Lab suggestive plus clinical evidence:

Lab suggestive – haematuria >10/uL PLUS recent strep infection (positive culture, increased ASOT or increase antiDNaseB) PLUS reduced C3

Clinical evidence – 2 of – facial oedema, peripheral oedema, hypertension, moderate haematuria on urinalysis

3. Actions

Paediatric referral

Notify health department

Public health interventions:

– community involvement (education of elders, health staff , teachers),

– control of scabies/skin sores (regular washing of children, treatment of scabies/ skin sores with im BenPen/Permethrin)

– Support of improved housing to reduce overcrowding and overuse of household facilities

– Screening of children between 12 months and 17 years for oedema and skin sores/scabies

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