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post-streptococcal glomerulonephritis

Etiology: 1) may follow group-A beta-hemolytic Streptococcal infection a) type 12 pharyngeal infection b) type 49 skin infection 2) immune complex disease with localization of streptococcal antigen-antibody complexes & complement in renal glomeruli Pathology: 1) many neutrophils (renal biopsy) 2) diffuse proliferative glomerulonephritis 3) glomeruli are markedly enlarged & hypercellular 4) electron microscopy: a) subepithelial immune deposits or humps b) mesangial deposits c) crescents 5) immunofluorescence demonstrates granular "lumpy-bumpy" pattern with IgG & C3 Clinical manifestations: 1) latent period a) type 12 pharyngeal infection: 6-21 days b) type 49 skin infection: 14-28 days 2) suddent onset edema, hematuria, renal insufficiency 2) see glomerulonephritis Laboratory: 1) urinalysis a) active urine sediment b) proteinuria generally < 3 g/24 hours c) fractional excretion of sodium (FENA) <1% d) hematuria 2) transiently low serum complement, CH50 & serum C3 (up to 8 weeks) 3) antibodies against streptococcal antigens a) antistreptolysin-O (ASO) in positive with pharyngeal infections b) anti-DNAse B is positive with skin infections c) antihyaluronidase antibodies d) antistreptokinase antbodies e) a change in titer indicates recent infection 4) renal biopsy Management: 1) no specific therapy 2) supportive: control of blood pressure & edema 3) penicillin for the patient & contacts may prevent new cases 4) prognosis is excellent unless crescents or persistent proteinuria is present 5) recovery of renal function in several weeks - proteinuria & hematuria resolve more slowly

Interactions

disease interactions

General

postinfectious glomerulonephritis; infection-related glomerulonephritis

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 270
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 605
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006