UMEM Educational Pearls

Title: Acute Poststreptococcal Glomerulonephritis

Posted: 7/29/2011 by Mimi Lu, MD
Click here to contact Mimi Lu, MD

Acute Poststreptococcal Glomerulonephritis (APSGN) is a sequela of group A beta-hemolytic streptococci (GAS) infection of the skin or pharynx with nephrogenic strains of GAS. Damage to the kidneys is due to deposition of antigen-antibody complexes in the glomeruli.

Presentation:

- Onset of APSGN averages 10 days after pharyngitis and 3 weeks following cellulitis.

- Nephritic syndome - hematuria (classically "coa-colored"), mild proteinuria, edema (periorbital), hypertension

- Additional symptoms: orthopnea, dyspnea (volume overload), lethargy, vomiting, fever, headache

Testing:

- Urinalysis (hematuria, proteinuria), creatinine (with subsequent hyperkalemia, acidosis)

- Bacterial cultures of skin or pharynx not useful as rarely positive at time of presentation

- Antistreptolysin O (ASO) titer elevated if preceding pharyngitis but rarely skin infections

- Antideoxyribonuclease B (anti-DNAse B) titers typically elevated in both

- Suppressed C3 level

Treatment:

- Predominately symptomatic: salt an water restriction

- Treatment of hyperkalemia, hypertension (loop diuretics)

- Antibiotics vs GAS (although does not affect clinical course of APSGN, eradicates GAS in individual and reduces transmission of nephrogenic GAS to community

- Profound renal failure may require hemodialysis or peritoneal dialysis

Prognosis (favorable):

- Hypertension and gross hematuria resolve over weeks (microscopic may last years)

- Proteinuria resolves over months

- Creatinine returns to baseline over 3-4 weeks

Reference:

Kit, Brian. Assess the volume status and electrolytes in children with poststreptococcal glomerulonephritis. Avoiding Common Pediatric Errors. 2008. p356-57.