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Post Infectious Glomerulonephritis 7/8

Myra Lalas. Post Infectious Glomerulonephritis 7/8. Epidemiology. Most common cause of AGN in children 5-15 yo Nonsuppurative sequelae of GAS infection of the pharynx or skin The median period between infection and the development of glomerulonephritis is 10 days. Pathophysiology.

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Post Infectious Glomerulonephritis 7/8

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  1. Myra Lalas Post Infectious Glomerulonephritis7/8

  2. Epidemiology • Most common cause of AGN in children • 5-15 yo • Nonsuppurative sequelae of GAS infection of the pharynx or skin • The median period between infection and the development of glomerulonephritis is 10 days.

  3. Pathophysiology • Certain M types are associated strongly with post-streptococcal glomerulonephritis (nephritogenic types). • APSGN has been shown to be nephritogenic following pharyngitis (strains 1, 3, 4, 12, 18, 25, and 49) or impetigo (strains 2, 49, 55, 57, and 60)

  4. Target streptococcal antigen is initially trapped within glomeruli Subsequent immune complex formation occurring in situ in the kidney Complement pathways are activated Followed by neutrophil infiltration and glomerular damage.

  5. Clinical Manifestations Symptoms Lab Findings • Edema • Gross hematuria • Hypertension • Hematuria • Proteinuria • Low C3, CH50 • Documentation of a recent GAS infection includes either a positive throat or skin culture or serologic tests (eg, ASO or streptozyme test).

  6. A biopsy is usually performed in patients in whom other glomerular disorders are being considered because they deviate from the natural course of the PSGN or they present late without a clear history of prior streptococcal infection.

  7. Differential Diagnosis • MPGN- Persistently low C3 levels beyond six weeks • IgA Nephropathy- recurrent episodes of hematuria • SLE • HSP

  8. Viral infections : Epstein Barr virus Parvovirus B19 Varicella Cytomegalovirus infection Coxsackie Rubella Mumps Hepatitis B • Parasitic infections Shistosoma mansoni Plasmodium falciparum Toxoplasma gondii Filaria

  9. Treatment • No specific therapy • Supportive care • Salt and water restriction • Loop diuretics • Patients with evidence of persistent group A streptococcal infection should be given a course of antibiotic therapy.

  10. The urinary abnormalities disappear at differing rates. • Hematuria usually resolves within three to six months. • Proteinuria also falls during recovery, but at a much slower rate.

  11. References Eddy Allison A, "Chapter 472. Glomerular Diseases" (Chapter). Colin D. Rudolph, Abraham M. Rudolph, George E. Lister, Lewis R. First, Anne A. Gershon: Rudolph's Pediatrics, 22e: http://www.accesspediatrics.com/content/7045367. Simckes, A. and A. Spitzer. Poststreptococcal Acute Glomerulonephritis. Pediatr. Rev. 1995;16;278-279 William W. Hay, Jr., Myron J. Levin, Judith M. Sondheimer, Robin R. Deterding, "Bacterial Infections" (Chapter). William W. Hay, Jr., Myron J. Levin, Judith M. Sondheimer, Robin R. Deterding: CURRENT Diagnosis & Treatment: Pediatrics, 20e www.uptodate.com

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