A Case of Acute Glomerulonephritis and Severe Uraemia, Treated with Heparin and Corticosteroids

A case of acute oliguric glomerulonephritis and severe uraemia treated with heparin is described. A 13-year-old girl developed streptococcal glomerulonephritis 4 weeks after having had a throat infection. The patient developed oliguria and rapidly progressive uraemia. Initially the coagulation status showed fibrinolytic split products in serum with low fibrinolytic activity and normal fibrinogen content. A local fibrin deposit with secondary fibrinolysis was suspected and heparin was given. In the course of combined treatment with penicillin, prednisolone and heparin, the patient improved. After 6 weeks renal function was normal and proteinuria had disappeared. Percutaneous renal biopsy, 6 months after the patient had fallen ill, showed only sequelae after glomerulonephritis and no signs of activity. It is concluded that, if there are signs of local fibrin deposits, treatment with heparin should be considered in cases of acute glomerulonephritis with severe uraemia and that the determination of fibrinolytic split products may be a valuable method to control the effect of the therapy and to follow the course of the disease.