Acute nephritic syndrome and glomerulonephritis — branching viva

Branching viva from the classic cola-urine presentation of post-streptococcal GN, through the complement rule and the eradication regimen, to the atypical child with persistent hypocomplementaemia or a rapidly progressive course that demands biopsy and immunosuppression, and finally to the IgA vasculitis child with nephritis.

branching clinical structured oral2 min readVerification in progress

Prompt

You are the paediatric registrar seeing children with haematuria and oedema across the ward and the emergency department. The examiner asks you to reason through three presentations: a six-year-old with classic post-streptococcal GN; a ten-year-old whose C3 has not normalised at eight weeks; and a seven-year-old with IgA vasculitis purpura and a nephritic urine. Information is released in stages.

Stem 1 — Six-year-old with cola-coloured urine (5 minutes)

A six-year-old boy presents with two days of smoky brown urine and morning periorbital puffiness. He had a sore throat two weeks ago. His blood pressure is at the 95th percentile and his urinalysis shows blood and protein with dysmorphic red cells and casts. [3] [6]

Branch A (examiner): Define the acute nephritic syndrome and name its four components. Why is this almost certainly post-streptococcal glomerulonephritis? [1] [3]

Branch B (examiner): What will his serum complement show, and by when should the C3 normalise? What follow-up blood test confirms the diagnosis, and what result would force you to change the diagnosis? [2] [11]

Branch C (examiner): Outline your supportive management. Name the eradication regimen, and explain clearly why penicillin does not reverse the glomerulonephritis itself. [3] [6]

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You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References12Show ledger

[1]Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int, 2021.PMID 34556256
[2]Sethi S; De Vriese AS; Fervenza FC Acute glomerulonephritis. Lancet, 2022.PMID 35461559
[3]Rodriguez-Iturbe B; Musser JM The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol, 2008.PMID 18667731
[4]Rodriguez-Iturbe B Autoimmunity in Acute Poststreptococcal GN: A Neglected Aspect of the Disease. J Am Soc Nephrol, 2021.PMID 33531351
[5]Nasr SH; Fidler ME; Valeri AM; et al Postinfectious glomerulonephritis in the elderly. J Am Soc Nephrol, 2011.PMID 21051737
[6]Balasubramanian R; Marks SD Post-infectious glomerulonephritis. Paediatr Int Child Health, 2017.PMID 28891413
[7]Oda T; Yoshizawa N Factors Affecting the Progression of Infection-Related Glomerulonephritis to Chronic Kidney Disease. Int J Mol Sci, 2021.PMID 33477598
[8]Pinto SW; do Nascimento Lima H; de Abreu TT; et al Twenty-year Follow-up of Patients With Epidemic Glomerulonephritis due to Streptococcus zooepidemicus in Brazil. Kidney Int Rep, 2022.PMID 36090503
[9]Reamy BV; Servey JT; Williams PM Henoch-Schonlein Purpura (IgA Vasculitis): Rapid Evidence Review. Am Fam Physician, 2020.PMID 32803924
[10]Mary AL; Clave S; Rousset-Rouviere C; et al Outcome of children with IgA vasculitis with nephritis treated with steroids: a matched controlled study. Pediatr Nephrol, 2023.PMID 37154959
[11]Iyengar A; Kamath N; Radhakrishnan J; et al Infection-Related Glomerulonephritis in Children and Adults. Semin Nephrol, 2023.PMID 38242806
[12]Wang Y; He Y; Cheng F; et al Optimal drug treatment for children with IgA vasculitis nephritis: a systematic review and network meta-analysis. Transl Pediatr, 2025.PMID 41502882