RapidlyProgressive Glomerulonephritis School Urinalysis : A Case Undetected by Routine Report

c A twelve year old girl with rapidly progressive glomerulonephritis (RPGN) is reported. First symptoms of renal failure deyeloped ill August 1987 just five months after a routine school urinalysis which detected no abnormalities. The patient developed end stage renal failure within 2 months of onset. Continuous ambulatory peritoneal dialysis (CAPD) was introduced to Tnanage the renal failure, and open renal biopsy was perfermed simultaneously in order to elucidate the underlying renal disease in this patient. Mieroscopic examination of the biopsy specimen demonstrated markcd forrnation of crescents {n about 90% of the glomeruli, and some of the glbmeruli were already selerotic. Granular depositions of IgG(trace), IgA(1 + ), IgM(3 + ), properdine(8 + ), Clq(S +) and C3(3 + ) were obseryed by immunofluorescence staining. A definite diagnosis of rapidly progressive glomerulonephritis was made as the cause of rcnal failure in this patient. It was suggested that open renal biopsy is useful in diagnosing the underlying kidney disease of end stage renal failure in cases where the clinical course is relatively short.