Acute Post Streptococcal Glomerulonephritis
DEFINITION
Is the sudden onset of
- Gross hematuria
- Oedema
- Hypertension
- Renal insufficiency
The most common cause of in children next is IgA nephropathy
AETIOLOGY-
- Follows infection of the throat or skin (Group A b-hemolytic streptococci).
CLINICAL MANIFESTATIONS
- Onset 1–2 wk after streptococcal infection.
- Oedema
- Hypertension
- Oliguria.
- Encephalopathy or heart failure due to hypertension
- Nephrotic syndrome may occur.
- Nonspecific symptoms such as malaise, lethargy, abdominal pain and fever
DIAGNOSIS.
- Urine – look for red blood cells (RBCs), casts and proteinuria, Polymorphonuclear leukocytosis
- Normochromic anaemia.
- Low serum C3 level
- Renal function tests
- A throat culture may be positive
- Elevated antibody titer to streptococcal antigen(s) – ASO titer
- Streptozyme test – detects antibodies to streptolysin O, DNase B, hyaluronidase
- Renal biopsy ordinarily is indicated.
COMPLICATIONS.
- Heart failure
- Hypertension
- Hyperkalemia
- Hyperphosphatemia/ Hypocalcemia
- Acidosis/ Seizures
- Uremia
PREVENTION.
Family members of patients with acute glomerulonephritis should be cultured for group A b hemolytic streptococci and treated if culture positive.
TREATMENT.
- Management is that of acute renal failure
- A 10-day course of systemic antibiotic – penicillin
- Bed rest if there is a complication
- Antihypertensive medications (diuretics, Angiotensin-converting enzyme inhibitors)
PROGNOSIS.
Complete recovery occurs in more than 95% of children