Post-streptococcal glomerular nephritis

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)

Diagnosis

Most common:

1. edema
2. gross hematuria
3. 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

1. CBC
2. Chem 7
3. UA (dysmorphic red blood cells, varying degrees of proteinuria, red blood cell casts, and pyuria)
4. Strep antigen serology

Differential Diagnosis

Causes of Glomerulonephritis

• Poststreptococcal glomerulonephritis
• Hemolytic-uremic syndrome
• Henoch-Schonlein purpura
• IgA nephropathy
• Lupus nephritis
• Alport syndrome
• Goodpasture syndrome
• Paraneoplastic

Treatment

1. Supportive management (treat volume overload)
   1. sodium and water restriction
   2. lasix (also controls HTN)
   3. consider dialysis (for acute renal failure)

Disposition

1. most have complete recovery, particularly children
2. resolution begins within the first two weeks
3. small subset have late renal complications (ie, hypertension, increasing proteinuria, and renal insufficiency)

See Also

Strep Pharyngitis

Source

KajiQuestions