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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.