Delay in Diagnosis in Poststreptococcal Glomerulonephritis
Received 23 December 2007; received in revised form 21 March 2008; accepted 4 April 2008. published online 21 May 2008.
Objective
To determine the frequency and risk factors for diagnostic delays in children with poststreptococcal glomerulonephritis (PSGN).
Study design
We reviewed the charts of 52 children with PSGN, and identified children with a delay in diagnosis of more than 24 hours. We determined risk factors for delay in diagnosis using univariate and multivariate logistic regression.
Results
17 children (33%) with PSGN had a delay in diagnosis. Delay in diagnosis occurred in 14% of children with gross hematuria as a presenting complaint and in 54% of children without gross hematuria as a presenting complaint (3.8 increased relative risk, 95% CI = 1.4 to 10; P = .02). A delay in diagnosis was more common in children with a negative infection history (P = .04). In multiple logistic regression, only the absence of gross hematuria as a presenting complaint was associated with a delay in diagnosis (P = .01). All children with a delay in diagnosis had microscopic hematuria on their initial urinalysis.
Conclusions
Delay in diagnosis is common in children with PSGN, especially if visible hematuria is not a presenting complaint. Physicians should consider the possibility of PSGN in children with symptoms that may be secondary to volume overload. A urinalysis is a helpful initial diagnostic test.
aDepartment of Pediatrics, Medical College of Wisconsin and the Children's Research Institute of the Children's Hospital of Wisconsin, Milwaukee, WI
bDepartment of Pediatrics (Nephrology), Emory University and Children's Healthcare of Atlanta, Atlanta, GA
Reprint requests: Dr. Larry A. Greenbaum, MD, PhD, Emory Children's Center, Division of Pediatric Nephrology, 2015 Uppergate Drive, NE, Atlanta, GA 30322
ABSTRACT