Clinical manifestations of acute glomerulonephritis include which of the following?
A. Chills and flank pain
B. Oliguria and generalized edema
C. Hematuria and proteinuria
D. Dysuria and hypotension
Correct Answer: C. Hematuria and proteinuria
Hematuria and proteinuria indicate acute glomerulonephritis. These findings result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis. The most common presenting symptom is gross hematuria as it occurs in 30 to 50% of cases with acute PSGN; patients often describe their urine as smoky, tea-colored, cola-colored, or rusty. The hematuria can be described as postpharyngitic (hematuria seen after weeks of infection).
Option A: Approximately 50% of children with PSGN are asymptomatic and are discovered accidentally during routine urine analysis. The classic triad of glomerulonephritis includes hematuria, edema, and hypertension. Typically, patients give a history of a recent streptococcal infection such as pharyngitis, tonsillitis, or impetigo.
Option B: The incidence of edema is seen in about 65-90% of the cases. Puffiness of the eyelids (periorbital edema) is typical for the nephritic syndrome. It is most prominent in the morning and tends to resolve at the end of the day. Generalized edema is also a common feature.
Option D: Renal involvement is common and is transient with recovery in 1-2 weeks. Less than half of the patients experience oliguria. Depending on the severity of renal involvement, signs, and symptoms suggestive of anuric renal failure or life-threatening acid-base imbalance, electrolyte abnormalities (especially hyperkalemia), and fluid overload would require RRT. About 60-80% of the patients experience high blood pressure which typically resolves in 10 days.
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