II. Epidemiology

  1. Previously, most common cause of Glomerulonephritis, but has decreased significantly in the U.S.
    1. As of 2018, most cases occur in underserved regions
  2. Previously most often in childhood (ages 2 to 6)
    1. Now more common in age >60 years old, especially with comorbidities

III. Pathophysiology

  1. Prototype for Acute Glomerulonephritis
  2. Follows Group A Beta Hemolytic Streptococcus Infection
  3. Onset 3 to 6 weeks after infection
    1. Streptococcal Pharyngitis
    2. Scarlet Fever

IV. Symptoms: Nephritic Syndrome

  1. Presentations vary
    1. May be as mild as asymptomatic Microscopic Hematuria
    2. May be as severe as Gross Hematuria with oliguric Acute Renal Failure
  2. Flank Pain is variably present
  3. General symptoms
    1. Headache
    2. Anorexia
    3. Nausea or Vomiting

V. Signs

VI. Labs

  1. Basic chemistry panel
    1. Acute Renal Failure may be present
    2. Serum Creatinine increased
  2. Urinalysis
    1. Proteinuria
  3. Group A Streptococcal Pharyngitis diagnosis
    1. GAS Rapid Strep Test with reflex to Throat Culture if negative
    2. ASO Titer increased on serial measurements
  4. Other labs
    1. Serum Complement decreased

VII. Diagnosis: Renal biopsy

  1. Indications: Diffuse proliferative Glomerulonephritis
    1. Severe or progressive Renal Failure
    2. Delayed resolution of clinical illness
    3. Systemic signs (Joint Pain, fever, Hepatomegaly)

VIII. Management

  1. Supportive care
  2. Edema and Hypertension
    1. Salt and water restriction
    2. Furosemide (Lasix)
      1. Management of edema and Hypertension, if present
  3. Acute Renal Failure
    1. Dialysis is rarely indicated
    2. Renal Function typically improves in 4-6 weeks after onset
  4. Urine
    1. Expect diuresis to occur in the first week of presentation
    2. Hematuria resolves in first 3-6 months
    3. Proteinuria typically resolves over first 3 years

IX. Prognosis

  1. Most cases are self limited (95%)
    1. Resolve within 4 weeks without residua
    2. Relapse is rare, but may occur
  2. Adults do worse then children
    1. Higher risk of Chronic Glomerulonephritis

X. References

  1. Rodriguez-Iturbe in Ferretti (2016) Streptococcus Pyogenes, Oklahoma City , University of Oklahoma HSC
    1. https://www.ncbi.nlm.nih.gov/books/NBK333429/
  2. Maness (2018) Am Fam Physician 97(8): 517-22 [PubMed]

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