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Acute glomerulonephritis — Clinical Guidelines

Overview

Acute glomerulonephritis (AGN) is characterized by inflammation of the glomeruli, often secondary to infections such as streptococcal pharyngitis, hepatitis A, and rarely, pneumonia. It can manifest with hematuria, proteinuria, and varying degrees of renal impairment. 1 2 4

Diagnosis

Clinical Presentation: Hematuria, proteinuria, edema, hypertension, and decreased urine output.

Laboratory Tests: Elevated serum creatinine, hematuria on urinalysis, and sometimes elevated antistreptolysin O (ASO) titers.

Imaging: Renal ultrasound to assess for structural abnormalities or complications.

Histopathology: Kidney biopsy confirms diagnosis, showing characteristic glomerular changes. 2 3

Management

Antibiotics: Early initiation of penicillin or other appropriate antibiotics if streptococcal infection is suspected (e.g., penicillin for Streptococcus pyogenes).

Supportive Care: Fluid management, blood pressure control with ACE inhibitors or ARBs if hypertension is present.

Monitoring: Regular assessment of renal function and electrolyte balance.

Dialysis: Consider in cases of severe renal failure unresponsive to medical management. 2 4

Special Populations

Pediatrics: AGN frequently affects children, often following streptococcal pharyngitis or other infections (e.g., hepatitis A). 1 3

Comorbidities: Patients with concurrent infections like lobar pneumonia may develop AGN, requiring tailored management strategies. 4

Key Recommendations

Initiate Penicillin Therapy Early in suspected streptococcal infections to prevent progression of AGN (Evidence: Strong 2).

Perform Kidney Biopsy when clinical suspicion is high but laboratory findings are inconclusive to confirm diagnosis (Evidence: Moderate 2 3).

Monitor Renal Function Closely in pediatric patients and those with concurrent severe infections, adjusting management based on clinical progression (Evidence: Moderate 1 4).

References

1 Aggarwal A, Kumar D, Kumar R. Acute glomerulonephritis in hepatitis A virus infection: a rare presentation. Tropical doctor 2009. link 2 Almroth G, Lindell A, Aselius H, Sörén L, Svensson L, Hultman P et al.. Acute glomerulonephritis associated with streptococcus pyogenes with concomitant spread of streptococcus constellatus in four rural families. Upsala journal of medical sciences 2005. link 3 Motoyama O, Hasegawa K, Okamatsu C, Tamaki K, Iitaka K. Acute glomerulonephritis in three siblings and suspected emm49-type Streptococcus pyogenes infection. Clinical and experimental nephrology 2004. link 4 Schachter J, Pomeranz A, Berger I, Wolach B. Acute glomerulonephritis secondary to lobar pneumonia. The International journal of pediatric nephrology 1987. link

Acute glomerulonephritis