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Post-streptococcal glomerular nephritis
From WikEM
Contents
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
- Poststreptococcal glomerulonephritis
- Hemolytic-uremic syndrome
- Henoch-Schonlein purpura
- IgA nephropathy
- Lupus nephritis
- Alport syndrome
- Goodpasture syndrome
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)
