Acute Poststreptococcal Glomerulonephritis
Acute poststreptococcal glomerulonephritis (also called acute glomerulonephritis) is relatively common. This disorder, a bilateral inflammation of the glomeruli, follows a streptococcal infection of the respiratory tract or, less often, a skin infection such as impetigo. It's most common in boys ages 3 to 7 but can occur at any age. Up to 95% of children and 70% of adults recover fully; the rest, especially elderly patients, may progress to chronic renal failure within months.
Signs and Symptoms
Symptoms of APSGN include:
Abnormal blood values (elevated electrolyte, blood urea nitrogen [BUN], and creatinine levels and decreased serum protein levels) and the presence of red blood cells, white blood cells, mixed cell casts, and protein in the urine indicate renal failure. (The proteinuria in an elderly patient usually isn't as pronounced.) Urine frequently contains high levels of fibrin-degradation products and C3 protein.
Elevated antistreptolysin-O titers (in 80% of patients), streptozyme and anti-DNase B titers, and low serum complement levels verify recent streptococcal infection. A throat culture may show group A betahemolytic streptococci.
Kidney-ureter-bladder X;rays show bilateral kidney enlargement. A renal biopsy may be necessary to confirm the diagnosis or assess renal tissue status.
The goal of treatment in poststreptococcal glomerulonephritis is to eliminate the streptococcal infection with antibiotics and provide supportive therapy until symptoms resolve. The goal of therapy is to relieve symptoms and prevent complications. Vigorous supportive care includes bed rest, fluid and dietary sodium restrictions, and correction of electrolyte imbalances (possibly with dialysis, but this is seldom necessary).
Treatment may include loop diuretics, such as metolazone or furosemide, to reduce extracellular fluid overload, and vasodilators, such as hydralazine or nifedipine. If the patient has a documented staphylococcal infection, antibiotics are recommended for 7 to 10 days; otherwise, their use is controversial.
Receiving prompt treatment for streptococcal infections may prevent APSGN.
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