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
- 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
- Poststreptococcal glomerulonephritis
- Hemolytic-uremic syndrome
- Henoch-Schonlein purpura
- IgA nephropathy
- Lupus nephritis
- Alport syndrome
- Goodpasture syndrome
- Paraneoplastic
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)
See Also
Strep Pharyngitis
References
- Geetha D et al. Poststreptococcal Glomerulonephritis Medication. eMedicine, Nov 2017. https://emedicine.medscape.com/article/240337-medication
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