acute poststreptococcal glomerulonephritis

Acute Post-Streptococcal Glomerulonephritis (APSGN) Description

Acute post-streptococcal glomerulonephritis (APSGN) is a kidney disorder that occurs after infection with certain strains of streptococcus bacteria. The condition is characterized by inflammation in the kidneys, which can lead to various symptoms.

Key Symptoms:

• Rust-colored urine: Due to the presence of red blood cells in the urine [5][9]
• Swelling (edema): Generalized swelling, including swelling of the abdomen, face, or eyes [5][8]
• Decreased urine output: Reduced urine production due to kidney dysfunction [5]
• Hematuria: Presence of red blood cells in the urine, which can be microscopic or grossly visible [3][6][9]

Clinical Presentation:

The clinical presentation of APSGN varies from asymptomatic cases with only microscopic hematuria to the full-blown acute nephritic syndrome. The condition is often preceded by a streptococcal infection, such as strep throat or scarlet fever.

Differential Diagnosis:

APSGN should be differentiated from other causes of acute glomerulonephritis, including non-infectious and infectious etiologies. A thorough clinical history and evidence of preceding group A strep infection are essential for a diagnosis [2].

Kidney Damage:

Long-term kidney damage can occur if APSGN is not properly managed. It is crucial to seek medical attention promptly if symptoms persist or worsen over time.

References: [1] - Not applicable (context provided) [2] Context result 2 [3] Context result 3 [5] Context result 5 [6] Context result 7 [8] Context result 8 [9] Context result 9

Common Signs and Symptoms

Acute poststreptococcal glomerulonephritis (APSGN) is a kidney disease that can cause various symptoms. The most common signs and symptoms include:

• Blood in the urine: Hematuria, or blood in the urine, is the most common symptom of APSGN [3].
• Swollen ankles or puffy eyes: Edema, or fluid retention, can cause swelling in the face, hands, feet, and abdomen [4].
• Decreased urine output: Patients may experience decreased urine production or a decrease in the amount of urine they need to urinate [2].
• Rust-colored urine: The urine may appear rust-colored due to the presence of blood [5].
• General swelling: Edema can cause general swelling, including swelling of the abdomen and face or eyes [5].
• High blood pressure: Hypertension is a common symptom of APSGN [7].

Other Possible Symptoms

In addition to these common symptoms, patients with APSGN may also experience:

• Fatigue due to anemia: Feeling tired or weak due to anemia [2].
• Nausea and vomiting: Some patients may experience nausea and vomiting [4].
• Muscle pain: Muscle aches or pains can occur in some cases [4].

Classic Triad

The classic triad of symptoms for APSGN includes:

• Gross hematuria
• Edema
• Hypertension

These three symptoms are the most common presenting symptoms, but not all patients will experience all three [10].

Acute poststreptococcal glomerulonephritis (APSGN) can be diagnosed through various diagnostic tests, which are essential for confirming the condition and ruling out other potential causes. Here are some of the key diagnostic tests used to diagnose APSGN:

• Laboratory studies: These include tests to provide evidence of preceding streptococcal infection, kidney function studies, and serologic studies. The most consistent and classic diagnostic finding is the presence of glomerular subepithelial electron-dense immune-type deposits [2].
• Kidney function tests: These are used to assess the overall health of the kidneys and can help identify any abnormalities in kidney function [3].
• Blood tests: Elevated levels of antistreptolysin O (ASO) and anti-DNase B antibodies in the blood suggest a recent group A strep infection, which is often associated with APSGN [8].
• Urine analysis: This can help identify proteinuria (excess protein in the urine), hematuria (blood in the urine), or other abnormalities that may indicate kidney damage [4].

It's worth noting that the diagnosis of APSGN is often based on a combination of clinical history, laboratory findings, and physical examination. A healthcare provider will typically consider a patient's medical history, symptoms, and test results to make an accurate diagnosis.

References:

[1] Niaudet P. Poststreptococcal glomerulonephritis. [2] The most consistent and classic diagnostic finding is the presence of glomerular subepithelial electron-dense immune-type deposits, often referred to as "humps" [2]. [3] Kidney function tests are used to assess the overall health of the kidneys and can help identify any abnormalities in kidney function [3]. [4] Urine analysis can help identify proteinuria (excess protein in the urine), hematuria (blood in the urine), or other abnormalities that may indicate kidney damage [4]. [8] Elevated levels of antistreptolysin O (ASO) and anti-DNase B antibodies in the blood suggest a recent group A strep infection, which is often associated with APSGN [8].

Treatment Overview

The management of acute poststreptococcal glomerulonephritis (APSGN) is mainly supportive in nature, with a focus on relieving symptoms and preventing further kidney damage. While there is no specific treatment for APSGN, various medications may be used to manage the condition.

Medications Used

• Antibiotics: Antibiotics such as penicillin or erythromycin are often administered to ensure eradication of the streptococcus bacteria if the disease is believed to be acute poststreptococcal glomerulonephritis and if risk of contamination is present [2].
• Blood pressure medicines: Blood pressure medications may be prescribed to control high blood pressure, which can occur in some cases of APSGN [3].
• Diuretic drugs: Diuretics may be used to manage swelling caused by fluid retention [3].
• Dialysis: In severe cases of kidney failure, dialysis may be necessary to remove waste products from the blood and help balance fluids [11].

Immunosuppressive Therapy

In some cases, immunosuppressive therapy may be considered to reduce inflammation in the kidneys. However, a study found that combined immunosuppressants showed no advantages over supportive therapy alone [7].

Newer Therapies

More recent studies have explored the use of newer therapies such as eculizumab, which has been successfully used to treat severe cases of APSGN [8]. Additionally, aspirin or other nonsteroidal anti-inflammatory drugs may be effective for treating arthritis associated with APSGN [9].

Conclusion

While there is no specific treatment for acute poststreptococcal glomerulonephritis, various medications and therapies may be used to manage symptoms and prevent further kidney damage. The goal of treatment is to protect the kidneys from further damage and preserve kidney function.

References:

[2] - Administering antibiotics to ensure eradication of streptococcus bacteria [3] - Using blood pressure medicines and diuretic drugs to manage high blood pressure and swelling [7] - Considering immunosuppressive therapy in severe cases [8] - Using eculizumab to treat severe APSGN [9] - Treating arthritis with aspirin or nonsteroidal anti-inflammatory drugs [11] - Performing dialysis in severe kidney failure

The differential diagnosis of acute poststreptococcal glomerulonephritis (APSGN) includes various other types of childhood glomerulonephritides, such as:

• IgA nephropathy
• Membranoproliferative glomerulonephritis
• Hereditary nephritis
• Other forms of postinfectious glomerulonephritis

Additionally, the differential diagnosis also includes other infectious and non-infectious causes of acute glomerulonephritis. These can include:

• Lupus nephritis
• Diabetic nephropathy with superimposed glomerulonephritis
• Multisystem disease
• Other primary glomerular diseases
• Nonstreptococcal postinfectious glomerulonephritis

It's worth noting that the differential diagnosis of APSGN can be extensive, and a thorough evaluation is necessary to secure an accurate diagnosis.

References:

• [1] - The differential diagnosis includes most other types of childhood glomerulonephritides.
• [4] - The differential diagnosis of PSGN includes other infectious and non-infectious causes of acute glomerulonephritis.
• [8] - The differential diagnosis includes multisystem disease, other primary glomerular diseases, nonstreptococcal postinfectious glomerulonephritis, and urinary tract infections.
• [13] - An overview of the differential diagnosis and evaluation of glomerular disease is presented in this topic.