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Poststreptococcal glomerulonephritis

Last updated: July 9, 2020

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Poststreptococcal (or postinfectious) glomerulonephritis (PSGN) refers to acute glomerular inflammation that results from a preceding infection with nephritogenic strains of streptococci. Although most commonly seen in children following group A streptococcal tonsillopharyngitis, skin infections such as impetigo may trigger PSGN as well. Deposition of immune complexes containing the streptococcal antigen within the glomerular basement membrane results in complement activation and subsequent damage to the glomeruli. PSGN typically presents as a nephritic syndrome with hematuria, mild proteinuria, edema, and hypertension. Elevated antistreptolysin O titers (ASO), low complement levels, and elevated creatinine support the diagnosis. In children, close monitoring and supportive therapy facilitate the recovery process. While most children recover fully, the prognosis in adults is typically less favorable.

  • Mostly affects children (between the ages of 3–12 years); and patients > 60 years of age
  • The incidence has decreased in developed countries due to the systematic use of antibiotics and improved hygienic standards.

References:[1][2][3]

Epidemiological data refers to the US, unless otherwise specified.

References:[1][4]

References:[2]

References:[1][4]

References:[1][2][4]

The differential diagnoses listed here are not exhaustive.

In most cases the disease is self-limiting and only supportive treatment focused on the complications of volume overload is necessary.

References:[2][3][4]

Complications are more common in adults:

References:[1]

We list the most important complications. The selection is not exhaustive.

  • Recovery usually occurs within 6–8 weeks.
    • In children: restitution of kidney function in > 90% of cases
    • In some cases, urinalysis may remain abnormal for extended periods. Follow-ups are therefore important!
  • In adults, about 50% of patients suffer from persistently reduced renal function.

References:[1][3]

  1. Rajendra Bhimma, DCH (SA). Acute Poststreptococcal Glomerulonephritis. In: Langman CB, Acute Poststreptococcal Glomerulonephritis. New York, NY: WebMD. http://emedicine.medscape.com/article/980685-overview. Updated: November 2, 2016. Accessed: February 13, 2017.
  2. Niaudet P. Poststreptococcal glomerulonephritis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/poststreptococcal-glomerulonephritis?source=search_result&search=poststreptococcal%20glomerulonephritis&selectedTitle=1~56.Last updated: October 31, 2016. Accessed: April 5, 2017.
  3. Post-streptococcal glomerulonephritis.
  4. Goldman L, Schafer AI. Goldman-Cecil Medicine, 25th Edition. Elsevier ; 2016
  5. Herold G. Internal Medicine. Herold G ; 2014