Download Post Infectious Glomerulonephritis

Myra Lalas
POST INFECTIOUS
GLOMERULONEPHRITIS
7/8
Epidemiology
 Most common cause of AGN in children
 5-15 yo
 Nonsuppurative sequelae of GAS infection of
the pharynx or skin
 The median period between infection and the
development of glomerulonephritis is 10
days.
Pathophysiology
 Certain M types are associated strongly with
post-streptococcal glomerulonephritis
(nephritogenic types).
 APSGN has been shown to be nephritogenic
following pharyngitis (strains 1, 3, 4, 12, 18,
25, and 49) or impetigo (strains 2, 49, 55, 57,
and 60)
Target streptococcal antigen is initially trapped
within glomeruli
Subsequent immune complex formation
occurring in situ in the kidney
Complement pathways are activated
Followed by neutrophil infiltration and
glomerular damage.
Clinical Manifestations
Symptoms
Lab Findings
 Edema
 Hematuria
 Gross hematuria
 Proteinuria
 Hypertension
 Low C3, CH50
 Documentation of a recent
GAS infection includes
either a positive throat or
skin culture or serologic
tests (eg, ASO or
streptozyme test).
 A biopsy is usually performed in patients in
whom other glomerular disorders are being
considered because they deviate from the
natural course of the PSGN or they present
late without a clear history of prior
streptococcal infection.
Differential Diagnosis
 MPGN- Persistently low C3 levels beyond six
weeks
 IgA Nephropathy- recurrent episodes of
hematuria
 SLE
 HSP
 Viral infections :
Epstein Barr virus
Parvovirus B19
Varicella
Cytomegalovirus infection
Coxsackie
Rubella
Mumps
Hepatitis B
 Parasitic infections
Shistosoma mansoni
Plasmodium falciparum
Toxoplasma gondii
Filaria
Treatment
 No specific therapy
 Supportive care
 Salt and water restriction
 Loop diuretics
 Patients with evidence of persistent group A
streptococcal infection should be given a
course of antibiotic therapy.
 The urinary abnormalities disappear at
differing rates.
 Hematuria usually resolves within three to six
months.
 Proteinuria also falls during recovery, but at a
much slower rate.
References
Eddy Allison A, "Chapter 472. Glomerular Diseases" (Chapter). Colin D.
Rudolph, Abraham M. Rudolph, George E. Lister, Lewis R. First, Anne
A. Gershon: Rudolph's Pediatrics, 22e:
http://www.accesspediatrics.com/content/7045367.
Simckes, A. and A. Spitzer. Poststreptococcal Acute
Glomerulonephritis. Pediatr. Rev. 1995;16;278-279
William W. Hay, Jr., Myron J. Levin, Judith M. Sondheimer, Robin R.
Deterding, "Bacterial Infections" (Chapter). William W. Hay, Jr.,
Myron J. Levin, Judith M. Sondheimer, Robin R. Deterding:
CURRENT Diagnosis & Treatment: Pediatrics, 20e
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