Post-streptococcal glomerulonephritis natural history, complications and prognosis: Difference between revisions
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*Prognosis is generally excellent.<ref name="pmid18667731">{{cite journal |vauthors=Rodriguez-Iturbe B, Musser JM |title=The current state of poststreptococcal glomerulonephritis |journal=J. Am. Soc. Nephrol. |volume=19 |issue=10 |pages=1855–64 |date=October 2008 |pmid=18667731 |doi=10.1681/ASN.2008010092 |url=}}</ref><ref name="pmid2191230">{{cite journal |vauthors=Tejani A, Ingulli E |title=Poststreptococcal glomerulonephritis. Current clinical and pathologic concepts |journal=Nephron |volume=55 |issue=1 |pages=1–5 |date=1990 |pmid=2191230 |doi=10.1159/000185909 |url=}}</ref> | *Prognosis is generally excellent.<ref name="pmid18667731">{{cite journal |vauthors=Rodriguez-Iturbe B, Musser JM |title=The current state of poststreptococcal glomerulonephritis |journal=J. Am. Soc. Nephrol. |volume=19 |issue=10 |pages=1855–64 |date=October 2008 |pmid=18667731 |doi=10.1681/ASN.2008010092 |url=}}</ref><ref name="pmid2191230">{{cite journal |vauthors=Tejani A, Ingulli E |title=Poststreptococcal glomerulonephritis. Current clinical and pathologic concepts |journal=Nephron |volume=55 |issue=1 |pages=1–5 |date=1990 |pmid=2191230 |doi=10.1159/000185909 |url=}}</ref> | ||
*Some people develop recurrent [[proteinuria]] and [[renal dysfunction]] 10 to 40 years after the presentation.<ref name="pmid11479149">{{cite journal |vauthors=Pinto SW, Sesso R, Vasconcelos E, Watanabe YJ, Pansute AM |title=Follow-up of patients with epidemic poststreptococcal glomerulonephritis |journal=Am. J. Kidney Dis. |volume=38 |issue=2 |pages=249–55 |date=August 2001 |pmid=11479149 |doi=10.1053/ajkd.2001.26083 |url=}}</ref> | *Some people develop recurrent [[proteinuria]] and [[renal dysfunction]] 10 to 40 years after the presentation.<ref name="pmid11479149">{{cite journal |vauthors=Pinto SW, Sesso R, Vasconcelos E, Watanabe YJ, Pansute AM |title=Follow-up of patients with epidemic poststreptococcal glomerulonephritis |journal=Am. J. Kidney Dis. |volume=38 |issue=2 |pages=249–55 |date=August 2001 |pmid=11479149 |doi=10.1053/ajkd.2001.26083 |url=}}</ref> | ||
*Age and presence of comorbidities are the most important prognostic factors for PSGN. | |||
*Children have an excellent prognosis with a <1% rate of azotemia, and a 3-10% rate of non-nephrotic range proteinuria, microhematuria, and hypertension. Nonetheless, the prognosis of PSGN in children might vary depending on individual co-morbidities, such as diabetes, obesity, and low birth weight.<ref name="pmid18667731">{{cite journal| author=Rodriguez-Iturbe B, Musser JM| title=The current state of poststreptococcal glomerulonephritis. | journal=J Am Soc Nephrol | year= 2008 | volume= 19 | issue= 10 | pages= 1855-64 | pmid=18667731 | doi=10.1681/ASN.2008010092 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18667731 }} </ref> | |||
Age and presence of comorbidities are the most important prognostic factors for PSGN. Children have an excellent prognosis with a <1% rate of azotemia, and a 3-10% rate of non-nephrotic range proteinuria, microhematuria, and hypertension. Nonetheless, the prognosis of PSGN in children might vary depending on individual co-morbidities, such as diabetes, obesity, and low birth weight.<ref name="pmid18667731">{{cite journal| author=Rodriguez-Iturbe B, Musser JM| title=The current state of poststreptococcal glomerulonephritis. | journal=J Am Soc Nephrol | year= 2008 | volume= 19 | issue= 10 | pages= 1855-64 | pmid=18667731 | doi=10.1681/ASN.2008010092 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18667731 }} </ref> | *Elderly patients with PSGN who often have co-morbidities have a comparatively much poorer prognosis with a 60% rate of azotemia, 40% rate of congestive heart failure, and 20% rate of nephrotic syndrome.<ref name="pmid3631152">{{cite journal| author=Melby PC, Musick WD, Luger AM, Khanna R| title=Poststreptococcal glomerulonephritis in the elderly. Report of a case and review of the literature. | journal=Am J Nephrol | year= 1987 | volume= 7 | issue= 3 | pages= 235-40 | pmid=3631152 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3631152 }} </ref><ref name="pmid8050205">{{cite journal| author=Washio M, Oh Y, Okuda S, Yanase T, Miishima C, Fujimi S et al.| title=Clinicopathological study of poststreptococcal glomerulonephritis in the elderly. | journal=Clin Nephrol | year= 1994 | volume= 41 | issue= 5 | pages= 265-70 | pmid=8050205 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8050205 }} </ref> Finally, the death rate of elderly patients with PSGN is substantial; it reaches up to 20-25%.<ref name="pmid3631152">{{cite journal| author=Melby PC, Musick WD, Luger AM, Khanna R| title=Poststreptococcal glomerulonephritis in the elderly. Report of a case and review of the literature. | journal=Am J Nephrol | year= 1987 | volume= 7 | issue= 3 | pages= 235-40 | pmid=3631152 |doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3631152 }} </ref><ref name="pmid8050205">{{cite journal| author=Washio M, Oh Y, Okuda S, Yanase T, Miishima C, Fujimi S et al.| title=Clinicopathological study of poststreptococcal glomerulonephritis in the elderly. |journal=Clin Nephrol | year= 1994 | volume= 41 | issue= 5 | pages= 265-70 | pmid=8050205 | doi= | pmc=| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8050205 }} </ref> Overall, full recovery of PSGN in elderly patients is observed in less than 50% of the cases.<ref name="pmid18204367">{{cite journal| author=Nasr SH, Markowitz GS, Stokes MB, Said SM, Valeri AM, D'Agati VD| title=Acute postinfectious glomerulonephritis in the modern era: experience with 86 adults and review of the literature. | journal=Medicine (Baltimore) | year= 2008 | volume= 87 | issue= 1 | pages= 21-32 | pmid=18204367 | doi=10.1097/md.0b013e318161b0fc | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18204367 }} </ref> | ||
The recurrence of PSGN is very rare and perhaps is almost never seen.<ref name="pmid17342179">{{cite journal| author=Rodríguez-Iturbe B, Batsford S| title=Pathogenesis of poststreptococcal glomerulonephritis a century after Clemens von Pirquet. | journal=Kidney Int | year= 2007 | volume= 71 | issue= 11 | pages= 1094-104 | pmid=17342179 | doi=10.1038/sj.ki.5002169 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17342179 }} </ref> This is explained by the immunogenic nature of the disease and the presence of subsequent life-long immunity.<ref name="pmid17342179">{{cite journal| author=Rodríguez-Iturbe B, Batsford S| title=Pathogenesis of poststreptococcal glomerulonephritis a century after Clemens von Pirquet. | journal=Kidney Int | year= 2007 | volume= 71 | issue= 11 | pages= 1094-104 | pmid=17342179 | doi=10.1038/sj.ki.5002169 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17342179 }} </ref> The progression into renal failure is not very common; it is present usually in elderly patients who continue to have persistent proteinuria following acute PSGN.<ref name="pmid3748251">{{cite journal| author=Vogl W, Renke M, Mayer-Eichberger D, Schmitt H, Bohle A| title=Long-term prognosis for endocapillary glomerulonephritis of poststreptococcal type in children and adults. | journal=Nephron | year= 1986 | volume= 44 | issue= 1 | pages= 58-65 | pmid=3748251 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3748251 }} </ref> | The recurrence of PSGN is very rare and perhaps is almost never seen.<ref name="pmid17342179">{{cite journal| author=Rodríguez-Iturbe B, Batsford S| title=Pathogenesis of poststreptococcal glomerulonephritis a century after Clemens von Pirquet. | journal=Kidney Int | year= 2007 | volume= 71 | issue= 11 | pages= 1094-104 | pmid=17342179 | doi=10.1038/sj.ki.5002169 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17342179 }} </ref> This is explained by the immunogenic nature of the disease and the presence of subsequent life-long immunity.<ref name="pmid17342179">{{cite journal| author=Rodríguez-Iturbe B, Batsford S| title=Pathogenesis of poststreptococcal glomerulonephritis a century after Clemens von Pirquet. | journal=Kidney Int | year= 2007 | volume= 71 | issue= 11 | pages= 1094-104 | pmid=17342179 | doi=10.1038/sj.ki.5002169 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17342179 }} </ref> The progression into renal failure is not very common; it is present usually in elderly patients who continue to have persistent proteinuria following acute PSGN.<ref name="pmid3748251">{{cite journal| author=Vogl W, Renke M, Mayer-Eichberger D, Schmitt H, Bohle A| title=Long-term prognosis for endocapillary glomerulonephritis of poststreptococcal type in children and adults. | journal=Nephron | year= 1986 | volume= 44 | issue= 1 | pages= 58-65 | pmid=3748251 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3748251 }} </ref> | ||
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Overview
Natural History, Complications, and Prognosis
Natural History
- The symptoms of post-streptococcal glomerulonephritis typically develop one to three weeks after exposure to group A streptococcal throat infection and 3 to 6 weeks after group A streptococcal skin infection.
- If left untreated, patients with post-streptococcal glomerulonephritis may progress to develop renal failure.[1]
Complications
Common complications of post-streptococcal glomerulonephritis include:[2][3][4]
- Severe nephritis
- Renal failure
- Atypical hemolytic uremic syndrome
- Refractory hypoxic respiratory failure
- Seizures
Prognosis
- Prognosis is generally excellent.[5][6]
- Some people develop recurrent proteinuria and renal dysfunction 10 to 40 years after the presentation.[7]
- Age and presence of comorbidities are the most important prognostic factors for PSGN.
- Children have an excellent prognosis with a <1% rate of azotemia, and a 3-10% rate of non-nephrotic range proteinuria, microhematuria, and hypertension. Nonetheless, the prognosis of PSGN in children might vary depending on individual co-morbidities, such as diabetes, obesity, and low birth weight.[5]
- Elderly patients with PSGN who often have co-morbidities have a comparatively much poorer prognosis with a 60% rate of azotemia, 40% rate of congestive heart failure, and 20% rate of nephrotic syndrome.[8][9] Finally, the death rate of elderly patients with PSGN is substantial; it reaches up to 20-25%.[8][9] Overall, full recovery of PSGN in elderly patients is observed in less than 50% of the cases.[10]
The recurrence of PSGN is very rare and perhaps is almost never seen.[11] This is explained by the immunogenic nature of the disease and the presence of subsequent life-long immunity.[11] The progression into renal failure is not very common; it is present usually in elderly patients who continue to have persistent proteinuria following acute PSGN.[12]
References
- ↑ Ayoob RM, Schwaderer AL (2016). "Acute Kidney Injury and Atypical Features during Pediatric Poststreptococcal Glomerulonephritis". Int J Nephrol. 2016: 5163065. doi:10.1155/2016/5163065. PMC 5011525. PMID 27642522.
- ↑ Kakajiwala A, Bhatti T, Kaplan BS, Ruebner RL, Copelovitch L (February 2016). "Post-streptococcal glomerulonephritis associated with atypical hemolytic uremic syndrome: to treat or not to treat with eculizumab?". Clin Kidney J. 9 (1): 90–6. doi:10.1093/ckj/sfv119. PMC 4720198. PMID 26798467.
- ↑ Mara-Koosham G, Stoltze K, Aday J, Rendon P (2016). "Pulmonary Renal Syndrome After Streptococcal Pharyngitis: A Case Report". J Investig Med High Impact Case Rep. 4 (2): 2324709616646127. doi:10.1177/2324709616646127. PMC 4871206. PMID 27231692.
- ↑ Adikari M, Priyangika D, Marasingha I, Thamotheram S, Premawansa G (September 2014). "Post-streptococcal glomerulonephritis leading to posterior reversible encephalopathy syndrome: a case report". BMC Res Notes. 7: 644. doi:10.1186/1756-0500-7-644. PMC 4175190. PMID 25218027.
- ↑ 5.0 5.1 Rodriguez-Iturbe B, Musser JM (October 2008). "The current state of poststreptococcal glomerulonephritis". J. Am. Soc. Nephrol. 19 (10): 1855–64. doi:10.1681/ASN.2008010092. PMID 18667731.
- ↑ Tejani A, Ingulli E (1990). "Poststreptococcal glomerulonephritis. Current clinical and pathologic concepts". Nephron. 55 (1): 1–5. doi:10.1159/000185909. PMID 2191230.
- ↑ Pinto SW, Sesso R, Vasconcelos E, Watanabe YJ, Pansute AM (August 2001). "Follow-up of patients with epidemic poststreptococcal glomerulonephritis". Am. J. Kidney Dis. 38 (2): 249–55. doi:10.1053/ajkd.2001.26083. PMID 11479149.
- ↑ 8.0 8.1 Melby PC, Musick WD, Luger AM, Khanna R (1987). "Poststreptococcal glomerulonephritis in the elderly. Report of a case and review of the literature". Am J Nephrol. 7 (3): 235–40. PMID 3631152.
- ↑ 9.0 9.1 Washio M, Oh Y, Okuda S, Yanase T, Miishima C, Fujimi S; et al. (1994). "Clinicopathological study of poststreptococcal glomerulonephritis in the elderly". Clin Nephrol. 41 (5): 265–70. PMID 8050205.
- ↑ Nasr SH, Markowitz GS, Stokes MB, Said SM, Valeri AM, D'Agati VD (2008). "Acute postinfectious glomerulonephritis in the modern era: experience with 86 adults and review of the literature". Medicine (Baltimore). 87 (1): 21–32. doi:10.1097/md.0b013e318161b0fc. PMID 18204367.
- ↑ 11.0 11.1 Rodríguez-Iturbe B, Batsford S (2007). "Pathogenesis of poststreptococcal glomerulonephritis a century after Clemens von Pirquet". Kidney Int. 71 (11): 1094–104. doi:10.1038/sj.ki.5002169. PMID 17342179.
- ↑ Vogl W, Renke M, Mayer-Eichberger D, Schmitt H, Bohle A (1986). "Long-term prognosis for endocapillary glomerulonephritis of poststreptococcal type in children and adults". Nephron. 44 (1): 58–65. PMID 3748251.