Post-streptococcal glomerular nephritis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Varies from asymptomatic to microscopic [[hematuria]] to acute nephritic syndrome (gross hematuria, [[proteinuria]], edema, [[hypertension]], and [[acute kidney injury]]) | |||
* | *Most common features: | ||
**Edema | |||
**Gross [[hematuria]] | |||
**[[Hypertension]] | |||
Varies from asymptomatic to microscopic hematuria to acute nephritic syndrome (gross hematuria, proteinuria, edema, hypertension, and acute kidney injury) | *History of recent [[strep]] infection (e.g. [[strep pharyngitis]], [[impetigo]]) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*Typically diagnosed by acute nephritis + recent GAS infection ([[strep pharyngitis]], [[impetigo]]) | |||
*CBC | *CBC | ||
*Chem 7 | *Chem 7 | ||
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*Supportive management (treat volume overload) | *Supportive management (treat volume overload) | ||
**Sodium and water restriction | **Sodium and water restriction | ||
** | **[[Furosemide]] (also controls hypertension) | ||
**Consider dialysis (for acute renal failure) | ***[[ACEi]] or [[CCBs]] for hypertension not controlled by diuretics<ref>Geetha D et al. Poststreptococcal Glomerulonephritis Medication. eMedicine, Nov 2017. https://emedicine.medscape.com/article/240337-medication</ref> | ||
**Consider [[dialysis]] (for acute [[renal failure]]) | |||
==Disposition== | ==Disposition== | ||
Latest revision as of 17:19, 16 October 2019
Background
- Abbreviation: PSGN
- Most common cause of acute nephritis worldwide
- Risk greatest in children 5-12 years old and adults >60
- Caused by glomerular immune complex disease induced by specific nephritogenic strains of group A beta-hemolytic streptococcus (GAS)
Clinical Features
- Varies from asymptomatic to microscopic hematuria to acute nephritic syndrome (gross hematuria, proteinuria, edema, hypertension, and acute kidney injury)
- Most common features:
- Edema
- Gross hematuria
- Hypertension
- History of recent strep infection (e.g. strep pharyngitis, impetigo)
Differential Diagnosis
Causes of Glomerulonephritis
- Poststreptococcal glomerulonephritis
- Hemolytic-uremic syndrome
- Henoch-Schonlein purpura
- IgA nephropathy
- Lupus nephritis
- Alport syndrome
- Goodpasture syndrome
- Paraneoplastic
Evaluation
- Typically diagnosed by acute nephritis + recent GAS infection (strep pharyngitis, impetigo)
- CBC
- Chem 7
- Streptozyme assay including ASO
- Complement C3, C4, C50
- Urinalysis (dysmorphic red blood cells, varying degrees of proteinuria, red blood cell casts, and pyuria)
Management
- Supportive management (treat volume overload)
- Sodium and water restriction
- Furosemide (also controls hypertension)
- Consider dialysis (for acute renal failure)
Disposition
- Most have complete recovery, particularly children
- Resolution begins within the first two weeks
- Small subset have late renal complications (ie, hypertension, increasing proteinuria, and renal insufficiency)
See Also
References
- ↑ Geetha D et al. Poststreptococcal Glomerulonephritis Medication. eMedicine, Nov 2017. https://emedicine.medscape.com/article/240337-medication