Abstract
Background:
Post-streptococcal glomerulonephritis (PSGN) is a common cause of acute nephritic syndrome in children. Rarely, it may result in life-threatening complications, including acute pulmonary edema and critical hyperkalemia.
Case Presentation:
We report a 10-year-old Yemeni girl (25 kg) presenting with severe respiratory distress, irritability, and generalized pitting edema. Laboratory tests confirmed PSGN with markedly reduced complement C3 (42.2 mg/dL) and nephritic urine sediment containing numerous red blood cells and casts. The patient developed critical hyperkalemia (7.0 mmol/L) and acute pulmonary edema, requiring urgent intubation and mechanical ventilation using pressure-controlled mandatory ventilation (P-CMV).
Management:
Aggressive fluid mobilization and electrolyte stabilization were initiated. High-dose intravenous furosemide (4 mg/kg/day) and low-dose dopamine (per local institutional protocols) were applied. Despite critical hyperkalemia, standard protocols (calcium, insulin-glucose) were unavailable; thus, potassium-lowering relied on continuous salbutamol and rapid diuresis. Appropriate adjunctive sedation was utilized briefly to facilitate mechanical ventilation. The patient produced 1700 mL urine in 17 hours, demonstrating a strong diuretic response. Continuous cardiac monitoring was maintained throughout the acute phase to mitigate arrhythmic complications.
Conclusion:
Early recognition of severe extra-renal complications in PSGN is critical. Intensive supportive care—including mechanical ventilation, meticulous fluid and electrolyte management, and appropriate sedation—is essential for survival in cases of acute pulmonary edema and critical hyperkalemia.