II. Epidemiology
- Previously, most common cause of Glomerulonephritis, but has decreased significantly in the U.S.
- As of 2018, most cases occur in underserved regions
- Previously most often in childhood (ages 2 to 6)
- Now more common in age >60 years old, especially with comorbidities
III. Pathophysiology
- Prototype for Acute Glomerulonephritis
- Follows Group A Beta Hemolytic Streptococcus Infection
- Onset 3 to 6 weeks after infection
IV. Symptoms: Nephritic Syndrome
- Presentations vary
- May be as mild as asymptomatic Microscopic Hematuria
- May be as severe as Gross Hematuria with oliguric Acute Renal Failure
- Flank Pain is variably present
- General symptoms
V. Signs
VI. Labs
- Basic chemistry panel
- Acute Renal Failure may be present
- Serum Creatinine increased
- Urinalysis
-
Group A Streptococcal Pharyngitis diagnosis
- GAS Rapid Strep Test with reflex to Throat Culture if negative
- ASO Titer increased on serial measurements
- Other labs
- Serum Complement decreased
VII. Diagnosis: Renal biopsy
- Indications: Diffuse proliferative Glomerulonephritis
- Severe or progressive Renal Failure
- Delayed resolution of clinical illness
- Systemic signs (Joint Pain, fever, Hepatomegaly)
VIII. Management
- Supportive care
-
Edema and Hypertension
- Salt and water restriction
- Furosemide (Lasix)
- Management of edema and Hypertension, if present
-
Acute Renal Failure
- Dialysis is rarely indicated
- Renal Function typically improves in 4-6 weeks after onset
- Urine
- Expect diuresis to occur in the first week of presentation
- Hematuria resolves in first 3-6 months
- Proteinuria typically resolves over first 3 years
IX. Prognosis
- Most cases are self limited (95%)
- Resolve within 4 weeks without residua
- Relapse is rare, but may occur
- Adults do worse then children
- Higher risk of Chronic Glomerulonephritis
X. References
- Rodriguez-Iturbe in Ferretti (2016) Streptococcus Pyogenes, Oklahoma City , University of Oklahoma HSC
- Maness (2018) Am Fam Physician 97(8): 517-22 [PubMed]