Post-streptococcal glomerular nephritis
Revision as of 04:03, 18 August 2015 by Neil.m.young (talk | contribs)
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:
- 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
- CBC
- Chem 7
- Streptozyme assay including ASO
- Complement C3, C4, C50
- UA (dysmorphic red blood cells, varying degrees of proteinuria, red blood cell casts, and pyuria)
Differential Diagnosis
Causes of Glomerulonephritis
- Poststreptococcal glomerulonephritis
- Hemolytic-uremic syndrome
- Henoch-Schonlein purpura
- IgA nephropathy
- Lupus nephritis
- Alport syndrome
- Goodpasture syndrome
- Paraneoplastic
Treatment
- Supportive management (treat volume overload)
- sodium and water restriction
- lasix (also controls HTN)
- 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)