La glomerulonefritis aguda en el niño: Estudio prospectivo de aspectos clinicos, histopatologicos e inmunologicos

Abstract

Forty live ehildren (23 boys) 22to 15 years old (mean age 7.7 years) with clinical and histological evidence ofacute glomerular nephritis (AGN) were followed by 30 months. A.II patients were studied with percutaneous renalbiopsies in tlic first month after the begining of the disease (mean 20 days) and in 31 patients, a second renal biopsywas done: in 12 at x 194 days (range 171 to" 212 days) and in 19 at x 590 days (range 418 to 999 days). With only 5exceptions (11.1%) all patients recalled clinical evidence of antecedent cutaneous (37.8%), respiratory (51.1%) orcombined cutaneous and respiratory infections (11.1%) but group A bctha hcmolitycus estrep toco ecus (GABHE)was only isolated from six patients, probably because of previous antibiotic treatment. Edema and hypertensiondissapearcd in a mean of 8.8 and 4.3 days respectively. Haematuria was present in only 44%of the patients in thefirst urine examination, protemuria in 51% and eilindruria in 29.9% of the cases, but at last, hematuria wasdemonstrated in 41 /45 patients; proteinuria, that was present in a!3 cases without hematuria, finally ocurred in 95%of all the affected children and eilindruria was detected in 64%of the total series. A good correlation was found inthe histologic study between the magnitude of the lesions at optic and electronic microscopy. In the first biopsy allpatients showed segmental intramembranous, inrnune deposits. In the second series of renal biopsies the intensity ofthe lesions was, clearly, lesser at six months and the microscopical findings were already normal in three cases at 590days.(Key words: Acute glomerular nephritis, symptoms, evolution, renal biopsy, histologic findings, follow up,prognosis).