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Acute post-streptococcal glomerulonephritis — Clinical Guidelines

Overview

Acute post-streptococcal glomerulonephritis (APSGN) is a renal complication following infection with group A Streptococcus, characterized by hematuria, proteinuria, and often hypertension, typically resolving within weeks to months 1 2 3 4.

Diagnosis

Clinical Presentation: Hematuria, proteinuria, edema, hypertension 1 2 3 4

Laboratory Tests: Elevated serum antistreptolysin O (ASO) titer, low complement levels (C3), increased urinary protein-to-creatinine ratio 1 2 3 4

Imaging: Renal ultrasound may show increased echogenicity 3

Renal Biopsy: Characteristic findings of immune complex deposition, typically crescentic glomerulonephritis 3 4

Management

Supportive Care: Fluid management, blood pressure control with ACE inhibitors or ARBs 3

Dietary Modifications: Low sodium diet to manage edema and hypertension 3

Monitoring: Regular follow-up for renal function, electrolyte balance, and complete blood count 1 3

Special Populations

Pediatrics: Increased awareness of rare complications such as gouty arthritis in obese children 1

Comorbidities: Coexistence with acute rheumatic fever; manage both conditions concurrently 3 4

Key Recommendations

Monitor serum complement levels (C3) and adjust management based on recovery trends (Evidence: Moderate) 1

Screen for and manage potential complications like gouty arthritis in pediatric patients, especially those with obesity (Evidence: Weak) 1

Recognize and treat concurrent acute rheumatic fever in patients presenting with APSGN (Evidence: Weak) 3 4

References

1 Kuniyoshi Y, Kamura A, Yasuda S, Tashiro M. Post-streptococcal acute glomerulonephritis complicated by gouty arthritis: a case report. Pediatric rheumatology online journal 2015. link 2 Feldon M, Dorfman L, Tauber T, Morad Y, Bistritzer T, Goldman M. Post-streptococcal glomerulonephritis and uveitis--a case report. Pediatric nephrology (Berlin, Germany) 2010. link 3 Narula AS, Mishra A, Anand AC, Gupta HS, Singh W. Post streptococcal glomerulonephritis co-existing with acute rheumatic fever--a case report. The Journal of the Association of Physicians of India 1992. link 4 Matsell DG, Baldree LA, DiSessa TG, Gaber LS, Stapleton FB. Acute poststreptococcal glomerulonephritis and acute rheumatic fever: occurrence in the same patient. Child nephrology and urology 1990. link

Acute post-streptococcal glomerulonephritis