Post-streptococcal glomerular nephritis: Difference between revisions

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

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)
  - ACEi or CCBs for hypertension not controlled by diuretics^[1]
- 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)

References

↑ Geetha D et al. Poststreptococcal Glomerulonephritis Medication. eMedicine, Nov 2017. https://emedicine.medscape.com/article/240337-medication

Authors:

[1] Geetha D et al. Poststreptococcal Glomerulonephritis Medication. eMedicine, Nov 2017. https://emedicine.medscape.com/article/240337-medication

[1]

@@ Line 1: / Line 1: @@
 ==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]])
--most common cause of acute nephritis worldwide
+==Differential Diagnosis==
+{{Glomerulonephritis causes}}
--risk greatest in children 5-12 years old and adults >60
+==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)
--caused by glomerular immune complex disease induced by specific nephritogenic strains of group A beta-hemolytic streptococcus (GAS)
+==Management==
+*Supportive management (treat volume overload)
+**Sodium and water restriction
+**[[Furosemide]] (also controls hypertension)
+***[[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==
+*Most have complete recovery, particularly children
-==Diagnosis==
+*Resolution begins within the first two weeks
+*Small subset have late renal complications (ie, hypertension, increasing proteinuria, and renal insufficiency)
-Most common:
-) edema
-) gross hematuria
-) hypertension
-Varies from asymptomatic to microscopic hematuria to acute nephritic syndrome (gross hematuria, proteinuria, edema, hypertension, and acute kidney injury)
-Typically diagnosed by acute nephritis + recent GAS infection
- ==Work-Up==
-CBCChem 7UA (dysmorphic red blood cells, varying degrees of proteinuria, red blood cell casts, and pyuria)Strep antigen serology ==DDx==
-Insert ==Treatment==
-Supportive management (treat volume overload)1) sodium and water restriction2) lasix (also controls HTN)3) 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==
+[[Strep_Pharyngitis|Strep Pharyngitis]]
+==References==
+<references/>
-Insert
+[[Category:Renal]]
+[[Category:ID]]
-==Source==
-KajiQuestions
-[[Category:GU]]