L DE SOUZA 1,2, I ISMAIL 1, M MANTHA 1
1Cairns Base Hospital, CAIRNS NORTH, Australia, 2Griffith University, Gold Coast, Australia
Aim: To highlight awareness and management of PIGN causing severe renal failure in an Indigenous adolescent patient at 23 weeks pregnancy, of which there are no known reports.
Background: Incidence of post-infectious glomerulonephritis (PIGN) remains high among remote Australian communities. Recent clusters were described from two areas in Far North Queensland – Weipa and Thursday Island.
Case Report: A 16-year-old Indigenous female at 23 weeks gestation of her first pregnancy presented with oliguria, microhaematuria (without red cell casts) and chronic impetigo (appeared some months prior) following 1 week history of diarrhoea and vomiting. She had documented normal kidney function 4 months earlier. Initial laboratory results revealed a serum creatinine of 402umol/L and hyperkalemia. Initial management with volume repletion, antibiotics and watchful biochemical monitoring showed subsequent improvements, and therefore presentation was presumed to reflect vasomotor acute kidney injury (AKI). However 4 days later she progressed to develop pulmonary oedema and severe hypertension requiring urgent haemodialysis. Further investigation showed low C3 (0.13g/L), negative dsDNA and ANA, hypoalbuminemia (nadir serum level 18g/L) and nephrotic range proteinuria (albumin-creatinine ratio 105g/mol creatinine). Skin swabs for microscopy and culture were positive for non-multi-resistant Staphylococcus aureus and Streptoccocus pyogenes. The diagnosis was presumed PIGN with the differential of IgA dominant PIGN. A kidney biopsy was not performed. Intensive daily dialysis was given with to maintain serum urea <10mmol/L. After 8 treatments she demonstrated renal recovery and dialysis was ceased. She then delivered a healthy 2.6kg child via spontaneous vaginal birth at 37+5 weeks.
Conclusions: Clinical awareness of PIGN in pregnancy is imperative to instigate intensive dialysis appropriately and optimise maternal – fetal outcomes.
Laura is a first year Renal Advanced Trainee at Cairns Base Hospital, with interests in improving Indigenous health in chronic kidney disease, supportive care and choice in kidney disease management, and sustainable medicine for the future of kidney disease.