Challenges in Establishing the Etiological Diagnosis of Acute Post-Streptococcal Glomerulonephritis in Children: A Report of Two Cases from the Pediatric Department of Libreville University Hospital

Abstract

Acute post-infectious glomerulonephritis particularly in its post-streptococcal form remains the most common nephropathy in children, with a notably high incidence in low-income countries where access to complementary investigations is limited. We describe two pediatric cases displaying the classic constellation of edema, hematuria, and hypertension, yet whose diagnostic confirmation proved challenging owing to the unavailability of tests such as complement C3 measurement or streptococcal detection. Both patients presented with acute renal failure and elevated ASO titers. Despite these constraints, the diagnosis was ultimately established, and penicillin therapy was initiated, leading to favorable clinical improvement within a few days. In such resource-limited settings, post-streptococcal glomerulonephritis must be approached primarily as a clinical diagnosis guided by blood pressure assessment and urine dipstick testing in order to prevent diagnostic delays and enhance patient care.