Case Study

Maria, a thirteen-year-old and the only daughter of a Mr and Mrs Santos who are both business owners, was
admitted to SUMC with complaints of flank pain, gross hematuria, edema, and hypertension with history of
impetigo and sore throat 2 weeks previously to the same hospital. Results from the previous microbial culture
showed disease is caused by prior infection with nephritogenic strains of Group A Streptococcus  (GAS).
Upon admission, Nurse Jibril observed that Maria anxiously holding her mother’s hand and was on the verge
of tears, “I don’t want to be back in the hospital again”, expressed the child. Nurse Jibril asked Maria to rate
the pain from 1-10, the girl verbalized “7”. The nurse performed physical examination, noting severe weakness
and increase in size of the right kidney on palpation of the right flank. However, no fever was determined, and
respiration were all normal.

Laboratory results revealed red urine with large amounts of blood, 0.1 g/dL (1 g/L) of protein, and small
amounts of leukocyte esterase, and elevated blood urea nitrogen of 9 mmoL/L (2.9mmoL/L-7.5 mmoL/L).
Microscopic examination reveals 30 to 49 red blood cells, 5 to 9 white blood cells. A complete blood cell
count reveals 13,600 white blood cells, a hemoglobin level of 8.2 g/dL (82 g/L) (reference range, 11.5–13.5
g/dL [115–135 g/L]), and 278,000 platelets, elevated ASOT (467 IU/ml), elevated serum creatinine of 110
mmol/L.

Her serum creatinine continued to rise over 2 weeks, and she had persistent hypertension. Given the prolonged
renal impairment, she underwent a kidney biopsy which revealed diffuse proliferative glomerulonephritis with
37% crescents. A definitive diagnosis of acute glomerulonephritis was established by the attending physician.