poststrep glomerulonephritis

Question 1

define post strep glomerulonephritis

Answer 1

acute glomerular inflammation that follows infection with nephritogenic strains of streptococci

Question 2

post strep glomerulonephritis is usually seen in

Answer 2

children following group A streptococcal tonsillopharyngitis
skin infections such as impetigo
bimodal age distribution: usually affects children 3-12 and patients over 60

Question 3

pathophysiology of post strep glomerulonephritis

Answer 3

infection with nephritogenic strains of group A beta haemolytic strep
immune complexes containing streptococcal antigen deposit within the GBM
compliment activation causes destruction of glomeruli
immune complex mediated glomerulonephritis and nephritic syndrome

Question 4

clinical features of post strep glomerulonephritis

Answer 4

50% remain asymtomatic
symptoms occur 1-6 weeks following acute infection
nephritic syndrome
influenze like symptoms
flank pain

Question 5

nephritic syndrome

Answer 5

haematuria - tea or cola coloured urine
hypertension - can lead to headaches
oedema (prominent facial oedema
oliguria

Question 6

urinalysis with microscopy

Answer 6

nephritic sediment
haematuria with RBC casts
proteinuria
pyuria

Question 7

quantification of proteinuria

Answer 7

typically shows non nephrotic protieuria

Question 8

metabolic panel

Answer 8

increased BUN
increased creatinine
electrolyte abnormalities

Question 9

FBC

Answer 9

may show normocytic, normochromic anaemia

Question 10

gaining evidence of preceding GAS infection

Answer 10

antistreptococcal antibody titers
isolation of group A beta haemolytic streptococci

Question 11

management of oedema overload

Answer 11

low sodium diet <2 g/day
fluid restriction
loop diuretics

Question 12

antihypertensives

Answer 12

indicated for hypertension refractory to managemnt of oedema and volume overload
preferred agents include calcium channel blockers, ACE I, ARBs

Question 13

antibiotic therapy

Answer 13

antibiotics will not affect the course of PSGN
but should be prescribed for those in active GAS infection to prevent complications eg. abscess, rhuematic fever
evidence of active infection eg. positive cultures for GAS

Question 14

complications of PSGN

Answer 14

complications are more common in adults
acute renal failure
rapidly progressive glomerulonephritis
nephrotic syndrome later in the course of the disease

Question 15

prognosis of PSGN

Answer 15

recovery in 6-8 weeks
restitution of kidney function in children > 90& of cases
50% of adult patients will suffer persistantly reduced kidney function