Post-streptococcal glomerulonephritis (patient information)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

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.

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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