POSTSTREPTOCOCCAL GLOMERULONEPHRITIS
 
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POSTSTREPTOCOCCAL GLOMERULONEPHRITIS

 

DEFINITION:

An acute glomerulonephritis caused by group A beta-hemolytic streptococci and characterized by hematuria, edema, and hypertension.

EPIDEMIOLOGY:

  • incidence: ?
    • most common cause of acute glomerulonephritis
  • age of onset:
    • appears most often in kids aged 7-10 years
  • risk factors:
    • common in Africa and SE Asia
    • M > F (2:1)

PATHOGENESIS:

1. Background

  • nephritogenic types of Streptococcus:
    • pharyngeal infection - serotypes 1, 4, or 12
    • cutaneous infection - serotypes 49, 55, 57, or 60
  • latent period:
    • pharyngeal infection - 5-21 days
    • cutaneous infection - 3-4 weeks
  • immune reaction to strep. antigenic components -> immune complex
  • IgG and C3 deposited on epithelial side of glomerular BM

CLINICAL FEATURES:

1. Renal Manifestations

1. Hematuria

  • microscopic (100%)
  • gross (30-67%)

2. Proteinuria

  • can progress to the nephrotic level

3. Complications

  • Nephritic Syndrome (edema [90%], hypertension [75%], azotemia, oliguria)
  • Nephrotic Syndrome (edema, hypoalbuminemia, hyperlipidemia)
  • Chronic Renal Failure (CRF)

 

Note: usually history of pharyngitis or impetigo about 10 days before the abrupt onset of dark urine with the acute phase lasting about 1 week

2. Systemic Manifestations

  • anorexia
  • abdominal pain
  • fever
  • headaches
  • lethargy
  • malaise
  • weakness

3. Complications

  • of Streptococcal Infections:
    • acute rheumatic fever
    • reactive arthritis

INVESTIGATIONS:

1. Urinalysis

  • hematuria, proteinuria (minimal -> nephrotic [in 25%])
  • microscope - glomerular pattern - damaged RBC's and RBC casts

2. Serum

  • depressed total complement, C3, or CH50
    • C3 will usually recover within 6-8 weeks
  • rising titres of antistreptococcal antibodies (ASO titres)
  • positive anti-DNase b
  • elevated ESR

3. Renal Biopsy

  • IgG and C3 deposited on the epithelial side of the glomerular basement membrane

MANAGEMENT:

1. Supportive

  • multidisciplinary approach
    • Paediatrics, Nephrology
    • conservative management and watch for complications

2. Medical

  • penicillin if streptococcal infection still active
  • medical management of complications:

1. Nephritic Syndrome

  • fluid restriction, control hypertension, manage hyperkalemia, manage pulmonary edema

2. Nephrotic Syndrome

  • fluid restriction, salt-free diet, diuretics, albumin transfusions, Prednisone, alkylating agents
  • see file on "Idiopathic Nephrotic Syndrome"

3. Chronic Renal Failure

  • dialysis, renal transplantation

3. Prognosis

1. Epidemic Form

  • excellent (<1% go onto renal failure)
  • may be recurrent hematuria

2. Sporadic Form

  • poorer - persistence of proteinuria as a rule
    • glomerulosclerosis, hypertension
    • decreased GFR

 

 

Pediatric Database - POSTSTREPTOCOCCAL GLOMERULONEPHRITIS

 

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