- Patrick Niaudet, MD
Patrick Niaudet, MD
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Hôpital Necker-Enfants Malades, Paris, France
Poststreptococcal glomerulonephritis (PSGN) is caused by prior infection with specific nephritogenic strains of group A beta-hemolytic streptococcus. The clinical presentation of PSGN varies from asymptomatic, microscopic hematuria to the full-blown acute nephritic syndrome, characterized by red to brown urine, proteinuria (which can reach the nephrotic range), edema, hypertension, and acute kidney injury. The prognosis is generally favorable, especially in children, but in some cases, the long-term prognosis is not benign.
The clinical manifestations, diagnosis, management, course of disease, and prognosis of PSGN will be reviewed here. Evaluation and causes of other glomerular disease in children are discusses separately. (See "Evaluation of a child with glomerular disease" and "Overview of the pathogenesis and causes of glomerulonephritis in children".)
Although PSGN continues to be the most common cause of acute nephritis in children globally, it primarily occurs in developing countries. Of the estimated 470,000 new annual cases of PSGN worldwide, 97 percent occur in regions of the world with poor socioeconomic status, with an annual incidence that ranges from 9.5 to 28.5 per 100,000 individuals [1,2].
In more developed and industrialized countries, the incidence has continued to decrease from the 1970s to the 1990s [2-4]. Based upon data from the Italian Biopsy registry, the estimated annual incidence was 0.3 per 100,000 individuals between 1992 and 1994 . The risk of PSGN is increased in older patients (greater than 60 years of age) and in children between 5 and 12 years of age [5,6]. PSGN is uncommon in children less than three years of age.
PSGN can present as a sporadic case or during an epidemic of group A streptococcal (GAS) infection (ie, skin and throat infections) . The incidence of clinically detectable PSGN in children infected during a GAS epidemic is about 5 to 10 percent with pharyngitis and 25 percent with skin infections [7,8].
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- Nephritogenic antigens
- Light microscopy
- Immunofluorescence microscopy
- Electron microscopy
- CLINICAL MANIFESTATIONS
- Clinical presentation
- Laboratory findings
- - Renal function
- - Urinalysis and urinary protein excretion
- - Complement
- - Culture
- - Serology
- DIFFERENTIAL DIAGNOSIS
- ACUTE MANAGEMENT
- Supportive care
- Indications for referral
- - Dialysis
- - Renal biopsy
- COURSE AND FOLLOW-UP
- Indications for renal biopsy
- Correlation with histologic recovery
- SUMMARY AND RECOMMENDATIONS