Principle Management of AGN

* In General NO specific Tx for AGN. The Tx is SYMPTOMATIC only

1) Confirm Dx of AGN (Send Ix)
    - BP (High) --> plot at BP centile 
    - UFEME & C+S --> RBC
    - BUSE --> Renal Fx
    - Ser C3($), C4 (n)
    - ASOT (>200 IU/mL)/ Throat/Skin swab & culture
    - FBC; Hb, TWBC

2) 10 days course of Penicillin
     - Initially IV C. Pen 30 mg/kg QID (1mg = 1667U)
     - Then change to PO Pen V 7.5-15 mg/kg QID

3) Tx Edema (d/t salt & water retention)
    - ROF & salt intake

4) Tx Hypertension (Diuretics/ AntiHPT)
    - T. Frusemide 1-2 mg/kg BD
    - T. Nifedipine 0.5-1 mg/kg BD

5) Tx Fever with Anti-Pyretics
    - PCM 15 mg/kg 4HRly (max 4g/day)
    * 1 Tab = 500 mg

6) Monitoring
   - Strict I/O Charting (plus urine colour)
   - Nephrotic Charting (daily albumin & BP target < 90th centile)
   - VSx 4HRly
   - RP daily ---> Renal failure

7) Monitor for Cx & Tx appropriately
   - HPT Encephalopathy -->
     c/o headace, vomiting, blurry vision, seizure, altered conscious
     * do Fundoscopy 
   - Acute Cardiac Failure
   - Acute Renal Failure (Oliguria < 300 mg/m²/day)
   - Progressive Glomerulonephritis 
   - Nephrotic Syndrome (Pro; nephrotic range 3+/ > 1g/m²/day)

8) Follow Up

   - For at least 1 year

   - Monitor BP every visit

   - UFEME & RP ---> asses recovery

   - repeat C3 6 weeks later if not normalised on the time of discharge 

9) Outcome

  - Short term: Excellent, mortality < 0.5%

  - Long term: 1.8% dev CKD; should referred to Paeds Nephrologist