penicillin only drug shown to reduce rates of acute rheumatic fever alternate first line: Amoxicillin

Poststreptococcal Glomerulonephritis Flashcards by Alice Richards

what type of strep causes psgn

GABS

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where is psgn mc

developing countries

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rf for psgn

4-15 yo

elderly

male

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mc cause of acute nephritis worlwide

psgn

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psgn develops __ weeks after an impetigo infxn

3-6

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psgn develops __ weeks after a pharyngitis infxn

1-3

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__ can be the only symptom of psgn

or the pt can have full __

microscopic hematuria

nephritic syndrome

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symptoms of nephritic syndrome (5)

red/brown urine

proteinuria

edema

htn

elevated serum creatinine

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mc presenting symptoms of nephritic syndrome

generalized edema

gross hematuria

htn

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systemic sx of psgn (4)

malaise

anorexia

flankl pain

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what will UA for psgn show (3)

RBCs

red cell clasts

proteinuria

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elevated renal values in psgn

BUN

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in psgn, serum complement will be __

bc __

low

acute immune rxn

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in psgn, what 3 serology tests are indicative of recent strep infxn

ASO (anti streptolysin O)

anti-DNAse

streptozyme

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what do you think when you see “honey colored crust” type rash around the mouth

strep impetigo infxn

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severe symptom of psgn

pulmonary htn

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why would we do strep serology over culture

w. normal swab test, it is unlikely that pt will still be positive for strep

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when does complement return to normal

6-8 weeks

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dx for psgn (2)

clinical findings

proof of recent GAS infxn

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what diagnostic test is not commonly performed for psgn

renal bx

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when would you perform renal bx for psgn

concern for:

lupus nephritis

IgA nephropathy

or other intrinsic renal issue

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goals of psgn tx

eradicate residual nephritogenic bacteria

supportive care

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there is no specific therapy for psgn, but __ especially needs to be taken care of

volume overload

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abx for psgn

penicillin

only drug shown to reduce rates of acute rheumatic fever*
alternate first line: Amoxicillin*

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tx for psgn for mildly penicillin allergic pt

cephalexin (Keflex)

abx for pt w. severe penicillin allergy

azithromycin

why do some not recommend abx for psgn

they don't alter the course of the disease *strep infxn already came and went*

abx for psgn might help to prevent

person to person spread

most pt's recover completely from psgn; 3 long term complications for pt's who do not (3)

HTN recurrent proteinuria renal insufficiency

when does Cr normalize in psgn

3-4 weeks

pt usually diureses w.in __ of psgn infxn

1 week

hematuria usually resolves in __ of psgn infxn

3-6 months

which sx resolves the slowest in psgn

proteinuria

rheumatic fever results from an __ rxn to GAS infxn

autoimmune

mc cause of heart disease in kids in developing countries

rheumatic fever

mc pt population w. rheumatic fever

5-14 yo

usual onset of rheumatic fever post GAS infxn

10 days

mc presentation pattern in rheumatic fever (2)

acute febrile illness → joint manifestations and/or carditis neurologic/behavioral manifestations → chorea

symptoms of rheumatic fever

**JONES:** **j**oint pain **o** (heart) - carditis **n**odular sq lesions **e**rythema/rash **s**ydenhams chorea

what sx is seen in 90% of pt w. rheumatic fever

fever duh!

signs of carditis in rheumatic fever (4)

dyspena orthopnea cp palpitations

describe the joint pain associated w. rheumatic fever (2)

large joints migratory

joint pain associated w. rheumatic fever has a dramatic response to

nsaids/salicylates

describe syndenham's chorea (4)

uncontrolled jerky movements limbs, face, tongue usually worse on one side stop wile sleeping

describe the nodular lesions associated w. rheumatic fever

painless resolve in 1-2 weeks

the rash associated w. rheumatic fever is called

erythema marginatum

you can't use jones criteria without

evidence of strep infxn

in jones criteria, you need __ major OR \_\_ major plus \_\_ minor

2 major OR 1 major PLUS 2 minor

major jones criteria (5)

joints → arthritis carditis and valvulitis subcutaneous nodules erythema marginatum CNS → usually Sydenham's

minor jones criteria (4)

arthralgia fever apr prolonged PR on ekg

4 main cardiac/ekg findings of rheumatoid fever

pr prolongation → AV block pancarditis mitral valve regurgitation S3

valve mc affected by rheumatic fever

mitral

tx for acute rheumatic fever

abx NSAIDs → for arthritis manage carditis

nsaid mc used for rheumatoid fever arthritis

aspirin *also naproxen*

NSAIDs for rheumatoid fever arthritis should be taken until

all joint sx have resolved

prophylactic abx for rheumatic fever

penicilin or clindamycin

abs directed hypersensitivity rxn against antigen on cells or extracellular materials (ex basement membrane)

type II

Ab-Ag complexes activate complement via **classic pathway,** causing cell lysis or extracellular tissue damage

type II hypersensitivity run

Ab Ag complexes promote tissue damage thru complement activation - **alternate pathway**

type III hypersensitivity run

Ab Ag complexes deposited in tissues

type III hypersensitivity run

acute rheumatic fever is a __ hypersensitivity rxn post streptococcal glomerulonephritis is a __ hypersensitivity rxn

acute rheumatic fever: II psgn: III