Male1: Sometimes, doctor worry about strep infection and not rheumatic fever, but sometimes, they are worried about a post strep nephritis type thing, and it has nothing to do with the throat, it is other kinds of strep. Everybody says, “Oh strep.” And they think sore throat, you are worried about maybe skin strep, what is that about? Can you explain a little bit more?
Male2: Strep is a bacteria, usually will give you a strep throat, but why do we worry as kidney doctors? Strep can cause a reaction in the body. It can cause inflammation in the kidneys. That usually happens about weeks after a sore throat. It is interesting because that can happen after a sore throat or after a skin infection as well. Usually, what we call impetigo, interesting in this country, 95% of the time, we get this inflammation of the kidney because of a sore throat and not of the skin infection.
What happens is that the kidney is inflamed and it presents as blood in the urine is usually the main presentation. Parents worry a lot that is a reflection of what is going on in the kidney. In the kidney, the kidney is inflamed, the urine may not—the patient may not urinate very well that the kidneys retains water, the child can get swollen.
Male1: Is the urine color—is there any unique color to it?
Male2: The most typical color is dark brown. What we call coca-cola color. Tea color--
Male1: Coca cola urine. So we can call this the coca-cola urine disease.
Male2: That is how people call it. And obviously--
Male1: Pepsi does not want to hear that.
Male2: Someone said this coca-cola, maybe we can call it Pepsi—I like to call it dark colored urine without brand names. The dark color urine, it is not a problem, but that is what brings the case to attention. Parents will come to the emergency room or to the pediatrician because of the dark urine, but we worry about the other problems. What happens when the kidney is inflamed and I worry about the retention of fluid, the decrease urine output and the increasing blood pressure that that increase the fluid.
Male1: So they get this thing called a nephritis or something?
Male2: That is what we call it, nephritis.
Male1: And it comes because you have antibody against the strep building up and unfortunately, it is not only attacking the strep, it is attacking your own kidney.
Male2: This is what we call a cross reaction. Immunologic cross reaction where the antibodies—they get in the strep in the throat, attack the kidney that has is kind of similar tissue so then the antibodies go into the kidney and cause all of these inflammation. What is interesting is that this inflammation could be from very, very mild and with the child only having a little bit of blood in the urine and nothing else, what could be very, very severe with the child or with blood in the urine, protein in the urine, a lot of fluid retention, a lot of swelling that are in the eyes, on the legs, and that can cause also severe high blood pressure, which can cause problems all around the body including the brain and that could be an emergency and my recommendation is to—when a child has something like this, they should come to the pediatrician right away, come to the ER right away and the patient needs to be seen as soon as possible.
Male1: The initial focus to control obviously all of the hypertension, but the strep, is it treatable at that point or is that—
Male2: Well, that is an interesting question because obviously, if you have a strep throat, we usually treat it with antibiotics, but what is interesting is that and it is not clear why, when you give antibiotics, you can prevent rheumatic fever which is a problem with the heart, but you cannot prevent these nephritis—what we call glumerular nephritis in the kidney. No one knows until now why we cannot prevent it. in my experience, if you treat the infection, maybe you cannot prevent it, but maybe the disease is going to be less severe. If you do not treat it, maybe if you get this nephritis, that the disease maybe be more severe, but this is just my clinical experience.
Male1: You suspect rheumatic fever, on it for a long time, do you do this with this disease too? Giving prophylactic antibiotics?
Male2: No. We do not need to give prophylactic antibiotics for this nephritis.
Male1: So your focus is treating whatever it did, treat the hypertension, inflammation of the parts of the body and does it always go away?
Male2: Well, most of the time, this is typically it is a self limited disease.
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