Paediatrics - Queensland Health - Queensland Government

Immune complications
Upper limits of normal BP levels
for girls at 50th percentile for
height and weight [1]
BP
upper level
systolic 104 105 108 111 115 119 123 126 128 129
of normal
diastolic 58 63 70 74 76 78 80 82 84 84
572
1 years
2 years
4 years
Diagnostic features of APSGN [2]
This illness usually features oedema and / or hypertension (BP greater than levels in tables
for age and gender). Other features include:
1. Haematuria - often macroscopic but can be microscopic
• A urine dipstick reading of ≥ 2+ red blood cells is adequate to define haematuria
• Microscopic haematuria is defined as >10 x 106 red blood cells on microscopy
of fresh urine; red cells casts should also be seen. If microscopy is not readily
available
2. Reduced serum complement: C 200 international units or,
• anti-DNase B >300 U / mL
• These serological titres are often high at baseline in Aboriginal and Torres Strait
Islander community children because of repeated skin infections with GAS. So
acceptable evidence for recent GAS infection is either:
-- titres of > 2 x reference e.g. ASOT > 400 international units / mL or
-- anti-DNase B > 600 units / mL or
-- a rising titre when repeated after 10 - 14 days
4. Management
• Consult MO who:
- - will advise to treat streptococcal infection with IM benzathine penicillin
[3] regardless of whether skin sores / sore throat are present at the time
of presentation or not; or if allergic to penicillin a full 10 day course of oral
roxithromycin [3]
-- may advise to treat hypertension and / or heart failure (initial treatment is
usually frusemide)
• All cases with hypertension should be evacuated / hospitalised
• Restrict fluids and salt intake (usually patient is fluid overloaded)
• Notify all cases of APSGN to the Public Health Unit
6 years
Controlled copy V1.0
8 years
10 years
12 years
14 years
16 years
> 17years
Primary Clinical Care Manual 2011