Post-streptococcal glomerulonephritis

 

Overview

Poststreptococcal glomerulonephritis (PSGN) is caused by preceding infection with nephritogenic strains of group A beta-hemolytic streptococcus. The intial clinical presentation of PSGN is usually asymptomatic then it progresses to microscopic hematuria, proteinuria , edema, hypertension, and symptoms of acute kidney injury. Common risk factors in the development of post-streptococcal glomerulonephritis include streptococcal throat infection and impetigo. Less common risk factors are household infection with the nephritogenic strain of group A streptococcal. Common complications of post-streptococcal glomerulonephritis include severe nephritis, renal failure , atypical hemolytic uremic syndrome , refractory hypoxic respiratory failure, and seizures. Prognosis is generally excellent but depends upon age and co-morbidities. Laboratory findings consistent with the diagnosis of streptococcal infection include antistreptolysin O (ASO) positive, antinicotinamide adenine dinucleotides positive, antihyaluronidase, and anti–DNAse B positive. Other abnormal laboratory findings include leukocytosis with neutrophilia, CRP is raised, increased levels of blood urea nitrogen (BUN) and serum creatinine levels are increased. On serologic testing, hypocomplementemia is usually found. On urinalysis, proteinuria, hematuria, and dysmorphic red cells are usually found. Effective measures for the primary prevention of post-streptococcal glomerulonephritis include improving hand hygiene, better housing, prevent overcrowding, treatment of an infected patient within 24 hours with antibiotics and prevent close contact. A 26-valent vaccine is recommended for children to prevent post-streptococcal glomerulonephritis. Effective measures for the secondary prevention of post-streptococcal glomerulonephritis include compliant with anti-hypertensive medication and follow up with the nephrologist.

What are the symptoms of Post-streptococcal glomerulonephritis?

Common symptoms of post-streptococcal glomerulonephritis include dark urine, oliguria, periorbital edema and hypertension. Less common symptoms of post-streptococcal glomerulonephritis include general malaise, weakness, anorexia, nausea and vomiting.

What causes Post-streptococcal glomerulonephritis?

Common causes of post-streptococcal glomerulonephritis include infection with group A streptococci. Others strain of streptococci which cause post-streptococcal glomerulonephritis include streptococci M types 47, 49, 55, 2, 60, and 57 causes pyodermatitis and streptococci M types 1, 2, 4, 3, 25, 49, and 12 causes throat infection. Less common causes of post-streptococcal glomerulonephritis include group C such as S. zooepidemicus and group G streptococcal infections.

Who is at highest risk?

The patient who is at risk for streptococcal infection is at the risk of PSGN.

Diagnosis

Doctors diagnose PSGN by looking at your medical history and ordering lab tests. Your doctor can test urine samples to look for protein and blood. Doctors can also do a blood test to see how well the kidneys are working and to see if you recently had a group A strep infection.

When to seek urgent medical care?

When there are signs of symptoms of streptococcal throat infections.

Treatment options

Treatment of PSGN focuses on managing symptoms as needed:

  • Decreasing swelling (edema) by limiting salt and water intake or by prescribing a medication that increases the flow of urine (diuretic)
  • Managing high blood pressure (hypertension) through blood pressure medication
  • In addition, people with PSGN who may still have group A strep in their throat are often provided with antibiotics, preferably penicillin.

Where to find medical care for Post-streptococcal glomerulonephritis?

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Prevention

The main way to prevent PSGN is to prevent group A strep infections like strep throat, scarlet fever, and impetigo. Getting a group A strep infection does not protect you from getting it again in the future and there are no vaccines to prevent group A strep. However, there are things you can do to protect yourself and others.
Hygiene:

  • The best way to keep from getting or spreading group A strep is to wash your hands often, especially after coughing or sneezing and before preparing foods or eating. To practice good hygiene you should:
  • Cover your mouth and nose with a tissue when you cough or sneeze
  • Put your used tissue in the wastebasket
  • Cough or sneeze into your upper sleeve or elbow, not your hands, if you don’t have a tissue
  • Wash your hands often with soap and water for at least 20 seconds
  • Use an alcohol-based hand rub if soap and water are not available
  • You should also wash glasses, utensils, and plates after someone who is sick uses them. After they have been washed, these items are safe for others to use

What to expect (Outlook/Prognosis)?

Prognosis is generally excellent.

  • Some people develop recurrent proteinuria and renal dysfunction 10 to 40 years after the presentation.
  • Age and presence of comorbidities are the most important prognostic factors for PSGN.
  • Children have an excellent prognosis with a <1% rate of azotemia, and a 3-10% rate of non-nephrotic range proteinuria, microhematuria, and hypertension.
  • The prognosis of PSGN in children might vary depending on individual co-morbidities, such as diabetes, obesity, and low birth weight.
  • Elderly patients with PSGN who often have co-morbidities have a comparatively much poorer prognosis with a 60% rate of azotemia, 40% rate of congestive heart failure, and 20% rate of nephrotic syndrome

Possible complications

Most people who develop PSGN recover within a few weeks without any complications, but rarely long-term kidney damage, including kidney failure, can occur. These rare complications are more common in adults than children.

Sources

https://www.cdc.gov/groupastrep/diseases-public/post-streptococcal.html

 

Attribution

This article incorporates public domain material from Wikidoc and MedlinePlus. Please see licenses for further details.

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