Acute post-streptococcal glomerulonephritis
Keywords:Acute post-streptococcal glomerulonephritis, Diagnosis, Treatment
Acute post-streptococcal glomerulonephritis (APSGN) is an immune-mediated renal disorder that occurs following an infection with certain strains of group A beta-hemolytic streptococci. This essay provides a comprehensive analysis of APSGN, covering its definition, causes, pathophysiology, clinical presentation, diagnosis, treatment, and prognosis.
APSGN arises 1-3 weeks after a streptococcal infection, primarily impetigo or pharyngitis caused by Streptococcus pyogenes. The immune response leads to the deposition of immune complexes in the glomeruli, activating complement and causing glomerular inflammation and injury.
Patients with APSGN commonly exhibit edema, hematuria, hypertension, and other symptoms such as oliguria, fatigue, and malaise. Diagnosis involves evaluating clinical features, laboratory findings, and serological tests. Urinalysis reveals hematuria, red blood cell casts, and proteinuria, while blood tests show elevated serum creatinine levels, decreased serum complement levels, and the presence of antistreptolysin O titers.
Management of APSGN focuses on supportive care and treating complications. Hospitalization may be necessary for severe cases, and measures include fluid and electrolyte balance, diuretics, and antihypertensive medications. Antibiotic therapy is generally not required unless an active streptococcal infection is present.
The prognosis for APSGN is generally favorable, with most patients experiencing complete recovery within weeks to months. However, chronic kidney disease can occur in rare cases. Complications may include hypertension, acute kidney injury, fluid overload, infections, and glomerular scarring.
Preventing APSGN involves timely diagnosis and treatment of streptococcal infections. Antibiotics, such as penicillin or erythromycin, help eradicate the bacteria, while good hygiene practices reduce the spread of streptococcal infections.
In conclusion, APSGN is an immune-mediated glomerulonephritis following streptococcal infection. Diagnosis relies on clinical presentation and laboratory tests, and treatment focuses on supportive care. Most cases have a favorable prognosis, highlighting the importance of preventive measures in reducing the incidence of APSGN.
Dhakal AK, Shrestha D, Singh SK, Acharya S. Clinical profile of children with acute post-streptococcal glomerulonephritis. Pediatr Nephrol. 2023 May 2. doi: 10.1007/s00467-023-05982-2. Epub ahead of print. PMID: 37130973.
Chong HC, Hung TY, Hohls A, Francis JR, Chaturvedi S. Clinical characteristics of hospitalised children with acute post-streptococcal glomerulonephritis in the Top End of Australia. J Paediatr Child Health. 2023;59(5):735-42.
Karakaya D, Güngör T, Çakıcı EK, Yazılıtaş F, Çelikkaya E, Yücebaş SC, et al. Predictors of rapidly progressive glomerulonephritis in acute poststreptococcal glomerulonephritis. Pediatr Nephrol. 2023 Mar 16. doi: 10.1007/s00467-023-05935-9. Epub ahead of print. PMID: 36929388.
Duong MD, Reidy KJ. Acute Postinfectious Glomerulonephritis. Pediatr Clin North Am. 2022;69(6):1051-78.
Kazi AM, Hashmi MF. Glomerulonephritis. 2023 Feb 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32809479.
Ong LT. Management and outcomes of acute post-streptococcal glomerulonephritis in children. World J Nephrol. 2022;11(5):139-45.
VanDeVoorde RG 3rd. Acute poststreptococcal glomerulonephritis: the most common acute glomerulonephritis. Pediatr Rev. 2015;36(1):3-12.
Brant Pinheiro SV, de Freitas VB, de Castro GV, Rufino Madeiro BC, de Araújo SA, Silva Ribeiro TF, et al. Acute Post-Streptococcal Glomerulonephritis in Children: A Comprehensive Review. Curr Med Chem. 2022;29(34):5543-59.
Hunt EAK, Somers MJG. Infection-Related Glomerulonephritis. Pediatr Clin North Am. 2019;66(1):59-72.
Eison TM, Ault BH, Jones DP, Chesney RW, Wyatt RJ. Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis. Pediatr Nephrol. 2011;26(2):165-80.
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