very good Angel. I am formally closing the forum on AGN. Please edit the initial soft copy you sent me, integrate as necessary the reactions from the class then resend the updated copy. Also, please submit a hard copy of both your papers to Prof. Butcon tomorrow.

I missed your reactions in the other forums

yes i agree with you ara. further research is needed on that area. And i think we should also address the concerns of parents. Having a child with AGN can be stressful for them. And they tend to be overprotective of the child. I think good communication skills will also be beneficial. How parents should explain the situation to their child...

I also want to share this study I found which might be of help in the detection and prevention of remissions of AGN among children. In this study they evaluate the oxidative stress (OS) status in children with AGN both at acute and remission stages and the study concluded that Oxidative stress may play important role in the pathogenesis of AGN and not be correlated with renal functions.

Oxidative stress is "an imbalance of the prooxidant antioxidant ratio in which too few antioxidants are produced or ingested or too many oxidizing agents are produced".(http://medical-dictionary.thefreedictionary.com/oxidative+stress)


Another explanation about this Oxidative stress is that it is "a term used to describe the effect of oxidation in which an abnormal level of reactive oxygen species (ROS), such as the free radicals (e.g. hydroxyl, nitric acid, superoxide) or the non-radicals (e.g. hydrogen peroxide, lipid peroxide) lead to damage (called oxidative damage) to specific molecules with consequential injury to cells or tissue. Increased production of ROS occurs as a result of fungal or viral infection, inflammation, ageing, UV radiation, pollution, excessive alcohol consumption, cigarette smoking, etc. Removal or neutralization of ROS is achieved with antioxidants, endogenous (e.g. catalase, glutathione, superoxide dismutase) or exogenous (e.g. vitamins A, C, E, bioflavonoids, carotenoids)".(http://medical-dictionary.thefreedictionary.com/oxidative+stress)



With this in mind, I think it would also be beneficial if we also include in our health teachings to parents with regards to home management about the importance of including anti-oxidant-rich food in the diet of their children with AGN, just to prevent remissions.

References

Bülbül, M., Öner, A., Demircin, G., & Erdoğan, Ö. (2008, February). Oxidative Stress in Children with Acute Glomerulonephritis. Renal Failure, 30(2), 209-214. Retrieved September 2, 2009, doi:10.1080/08860220701813319

Good point Ara, indeed the need for home-based monitoring cannot be understated. New research findings like this on potential effect on siblings of children with AGN should be disseminated and used to revitalize existing screening programs

Thank you Ara for your well- constructed reaction and additional information.

In relation to the kidney screening program in Japan, Yes we also have that kind of intervention in the Philippines. It is called Mass Urinary screening Program that was launched in June 1993 by the Department of Health in cooperation with many governmental and nongovernmental agencies. This was a project of the Philippine Preventive Nephrology Project for apparently health public elementary school children in grades 1 to 6.

Avner E., Harmon W., Niaudet P. 2009. Pediatric Nephrology.



Classmates I would be glad to clarify your concerns on AGN. It is posted on our yahoo groups. You can state some corrections and have some additional information. Please feel free to ask questions. Thank You.

Angel

angel.. i just want to emphasize the importance of home management of children with AGN. Actually, the important reminders that should be included in the home management instructions (for parents) are already interwoven in your report (specifically some of the interventions for your nursing diagnosis. These are the specifications on the diet and activity modification, protection from exposure to possible triggers of infection and many others. To add another point, there could be an add-on with this home management instructions. Most of them focuses on the sick child only. However, there is a research which shows that there is also a familial trend of AGN among the siblings of the sick child.

The research (which angel included in the report) "Occurrence of Acute Glomerulonepohritis in Sibling Contacts of Children with Sporadic AGN" revealed that Additional cases of acute glomerulonephritis in sibling contactswere observed in from one fourth (proven by renal biopsy) toone half (proven and suspected) of the index case sibships examined.

These data suggest that the occurrence of acute glomerulonephritisin family contacts of children with sporadic acute poststreptococcalglomerulonephritis is so common as to warrant close observationof the other siblings.

Possible guidelines to the parents can be given in monitoring for their other children's health. Also, I think further research can be done in this topic.

>>Dodge W., Spargo B. & Travis L., 1976. Occurrence of Acute Glomerulonepohritis in Sibling Contacts of Children with Sporadic AGN. American Journal of the American Academy of Pediatrics. pp.
1028-1030. Electronic Version Available at
http://pediatrics.aappublications.org/cgi/content/abstract/40/6/1028.
Retrieved on September 2, 2009

I just want to share this research in Japan. I am wondering if we have this kind of intervention in the
Philippines, then AGN for both children and adults will not be really a problem in the country. This highlights the importance of early detection and treatment in the outcomes of disease occurrence.

In Japan, they have an intervention "kidney disease screening program".
This is a heightened response to the increasing number CKD cases which
have a multiple of causes (including AGN). The screening program
applies for school children, wherein, all the students are subjected to
the free urinalysis and school based health examination.

The students who were positive in the first screening undergoes a second screening
after 3 months. Those who are positive for the two screenings are then
referred to a physician for further diagnosis and treatment.

This program really took effect with regards to the AGN cases in
children, there is a drop in the number of AGN cases. Statistics showed
that in 1998, new ESRD occurred in 4 per 1 millionchildren who were younger than 19 yr, whereas it occurred in15
per 1 million in the United States. This significant results are
attributed to the promt referral and treatment of the cases.

>> From: Imai K. et al, 2007. Kidney Disease Screening Program in
Japan:History, Outcomes, Perspectives. Clinical Journal of American
Society of Nephrology 2: 1360-1366. Electronic Version
available at http://cjasn.asnjournals.org/cgi/content/full/2/6/1360
retrieved on August 31, 2009