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)

Clinical Features

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 (strep pharyngitis, impetigo)

Differential Diagnosis

Causes of Glomerulonephritis

Evaluation

  • 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
    • Lasix (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

Strep Pharyngitis

References