History
When considering Alport syndrome, family history is important, especially to identify other family members with nephritis or renal failure. When considering poststreptococcal glomerulonephritis (GN), elicit a history of streptococcal throat or skin infection. Inquire about symptoms of swelling and facial, perioral, or pedal edema or ascites. Symptoms of pulmonary edema or congestive heart failure (eg, dyspnea with exertion, orthopnea, shortness of breath) may be present. Gross hematuria (eg, dark, rust colored, coke colored, tea colored) may be present. With severe hypertension, identify nosebleed, headache, or encephalopathy. The parent may note decreased urine frequency. Nonspecific symptoms, such as malaise, fever, anorexia, or weakness, may be present..
A recurrent history of gross hematuria triggered by infections may point to IgA nephropathy. Hearing loss may suggest Alport syndrome.
For children with tubulointerstitial nephritis (TIN) who present with allergic manifestations, most have fever (80-100%) and many have maculopapular rash (25-50%). These symptoms often occur with arthralgias and malaise. When considering the diagnosis of TIN, attempt to obtain a history of a known etiology (eg, bacterial, viral, drug-related, metabolic). In patients with TIN, a history of polyuria, rather than oliguria, is obtained.
Physical Examination
Elevated blood pressure is an important physical finding. Look for edema. The child may have a pale appearance because of dilutional anemia. Tachypnea, dyspnea, hepatic congestion, and gallop rhythm suggest fluid overload with congestive heart failure. If a secondary form of glomerulonephritis (GN) is suspected, seek physical findings of the condition (eg, vasculitis in SLE).
With tubulointerstitial nephritis (TIN), physical findings include maculopapular rash, joint pain (with flexion and extension), and fever. Rarely, the patient may present with uveitis as part of tubulointerstitial nephritis and uveitis syndrome (TINU). [7, 8]
