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Poststreptococcal

Glomerulonephritis
Etty Widyastuti
PSPD UNILA/Abdul Moeloek
Hospital

Poststreptococcal GN (Introduction)

Usually occurs 10 days


after pharyngitis and 14
days after skin infection

Common in some rural


areas, poor hygiene
places, and tropical
countries

Occurs more often in


males and children

Poststreptoccal GN (nephritic strains)

Known nephritic strains


include M types 1, 2, 4, 12,
18, 25, 49, 55, 57, 60
Many proposed
mechanisms: Molecular
mimickry vs. autoimmune
vs. polyclonal activation of
B lymphocytes
Repeat infections are not
common as immunity is
type specific and not
usually transient

Clinical Presentation

Most patients have milder disease


Classically, presents with overt
nephritic syndrome and oliguric
ARF
Symptoms can include gross
hematuria (100% microscopic),
hypertension(60-80%),
hypervolemia, and edema (8090%)

Clinical Presentation

Nephritic urinary
sediment
dysmorphic RBCs, red
cell casts, leukocytes,
subnephrotic
proteinuria
Nephrotic-range
proteinuria not
common

Laboratorium

Serum Cr can be commonly elevated at presentation, though


mild
C3 and CH50 decreased w/in 2 weeks
C4 usually normal (complement level usually normal within 68 weeks)
Most patients have directed Ab, such as ASO, anti-DNAse B,
etc
Serum IgG and IgM increased in 80% and returns to normal
in 1-2 months

Light Microscopy
On light microscopy,
usually see diffuse
proliferative GN

Electron Microscopy

large electron dense


immune deposits in
subendothelial,
subepithelial, and
mesangial areas

Course

Irreversible Renal Failure rare less than 1 % in


children, slightly higher in adults
Resolution usually quick, plasma Cr usually
returns to previous levels by 3-4 weeks
Hematuria resolves usually within 3-6 months,
proteinuria falls at a slower rate

Treatment

Eliminate strep infection with antibiotic


Supportive therapy
Diuretics and antihypertensives to control
blood pressure and extracellular fluid
volume

The End

References

Rose, Burton. Acute Glomerulonephritis and Pulmonary


Hemorrhage, Course of Poststreptococcal Glomerulonephritis. Up
To Date 2005.
Harrisons Online. Glomerular Disease. Ch 264. 2004-2005.
Niles JL, et al. The Syndrome of Lung Hemorrhage and Nephritis
is Usually an ANCA Associated Condition. Arch Intern Med.
1996; 156: 440-445.
Gallagher H, et al. Pulmonary Renal Syndrome: A 4 Year, SingleCenter Experience. Am J of Kidney Disease 2002; 39: 42-47.
Berrrios X, et al. Post-streptococcal Acute Glomerulonephritis in
Chile 20 Years of Experience. Pediatr Nephrol 2004; 19: 306312.
Johnson RJ, et al. Glomerular Disease Associated with Infection.
Ch 30. Comprehensive Clinical Nephrology. 2000.