PSGN and Rheumatic Fever

Question 1

What bacteria causes PSGN?

Answer 1

GABHS

Question 2

What are the two main nephitogenic antigens causing PSGN?

Answer 2

Nephritis associated plasmin receptor

Streptococcal pyogenic exotoxin B

Question 3

T/F? The MOST common cause of nephritis in children in the world is PSGN.

Answer 3

True

Question 4

What type of hypersensitivity reaction is PSGN?

Answer 4

Type III

Question 5

What type of hypersensitivity reaction is rheumatic fever?

Answer 5

Type II

Question 6

Common presenting symptoms of PSGN?

Answer 6

Generalized edema
Gross hematuria
HTN

Question 7

UA findings in PSGN?

Answer 7

RBCs, red cell casts, proteinuria

Question 8

Lab findings in PSGN?

Answer 8

increased BUN, Cr.
Low serum complement
+ ASO

Question 9

Describe a type III hypersensitivity reaction.

Answer 9

Immune complex formation and deposition in tissues leading to inflammatory reactions

Question 10

Describe a type II sensitivity reaction.

Answer 10

IgG/IgM antibody:antigen interactions on target cell surfaces

Question 11

What is needed to make the diagnosis of PSGN?

Answer 11

Clinical findings of acute nephritis
PLUS
recent GAS infection

Question 12

Treatment for PSGN?

Answer 12

Diuresis w/ furosemide, sodium and fluid restriction, treat strep infection if still present, treat hypertension if necessary.

Question 13

Drug of choice for treatment of strep infections? 2nd line?

Answer 13

Penicillin

2nd line: amoxicillin

Question 14

Treatment for strep infection in patients with PCN allergy?

Answer 14

Cephalexin if mild allergy

Azithromycin if anaphylactic reaction.

Question 15

T/F? Renal biopsy is necessary for diagnosis of PSGN?

Answer 15

false

Question 16

Prognosis for patients with PSGN?

Answer 16

Most have complete recovery, some develop HTN, proteinuria, renal insufficiency.

Question 17

When do rheumatic fever symptoms typically occur in relation to a strep infection?

Answer 17

10 days to several weeks after infection

Question 18

Common presentations of rheumatic fever?

Answer 18

Acute febrile illness with joint manifestations or carditis

Neurologic behavior and manifestations with chorea

Question 19

What criteria do you use to make diagnosis of rheumatic fever?

Answer 19

Jones Criteria

Question 20

How many of the Jones criteria do you need to make the diagnosis?

Answer 20

2 more or 1 major and 2 minor

Plus evidence of recent strep infection

Question 21

Major Jones criteria?

Answer 21

Carditis and valvulitis
Migratory polyarthritis
CNS involvement (chorea)
Subcutaneous nodules
Erythema marginatum

Question 22

Minor Jones Criteria

Answer 22

Arthralgia
Fever
Elevated acute phase reactants
Prolonged PR interval on EKG

Question 23

Treatment for acute rheumatic fever?

Answer 23

Penicillin

NSAIDs (ASA traditional 1st line, naproxen also a good choice)