POST SREPTOCOCCAL

GLOMERULONEPRHITIS
 DEFINITION

• Prototypical glomerular disease of

immune complex etiology
• Prototypic exogenous antigen-
induced disease pattern of acute
endocapillary proliferative
glomerulonephritis
(Robbins & Cotran, Pathologic Basis of Disease, 9th ed.)
 DEFINITION

Acute nephritic syndrome

• Gross hematuria
• Hypertension
• Edema
• Renal insufficiency (oliguria)

Nelson Textbook of Pediatrics, 20th ed

 EPIDEMIOLOGY

• 90% of renal disorders

• One of the leading cause requiring hospital admissions
• Acute renal failure in developing countries
• Ages 1-12 years and young adults
• Male > Female

Clinical Spectrum and Outcome of Acute Post Streptococcal Glomerulonephritis in Children. 2017. Observational Study by MSHEid, Assiut University.
 ETIOLOGY
• Nephritogenic strains of
group A Beta-hemolytic
streptococci
• Usually occurs
• 7-14 days after pharyngitis
• 2-6 weeks after skin
infection
Nelson Textbook of Pediatrics, 20th ed
 GROUP A STREPTOCOCCUS
• Streptococcus pyogenes
• URTI, skin
• Scarlet fever, erysipelas
• TSS, necrotizing fasciitis
• Rheumatic fever, acute
glomerulonephritis
Nelson Textbook of Pediatrics, 20th ed
 PATHOLOGY
• Gross: kidneys symmetrically
enlarged
• LM: enlarged, hypercellular
glomeruli
• IF: “lumpy-bumpy” deposits
• EM: dense deposits or
“humps:
 PATHOGENESIS

Molecular mimicry

In situ immune complex formation

Complement activation
Nelson Textbook of Pediatrics, 20th ed
 CLINICAL FEATURES
HEMATURIA
• Dark, smoky brown or cola-colored
• Glomerular: dysmorphic RBC, cast in freshly spun
urine
 CLINICAL FEATURES
PROTEINURIA
• Mild to moderate but nephrotic range is rare

OLIGURIA
• Transient – 50%
* Anuria - rare
 CLINICAL FEATURES
EDEMA - 85%
• Mild: periorbital or pedal
• Severe: hypertension, pleural effusion or ascites
• Adolescents: more likely face and legs
 CLINICAL FEATURES
HYPERTENSION - 80%
• Headache, somnolence, changes in mental status
• Anorexia, nausea, convulsion
 CLINICAL FEATURES
HYPERTENSIVE EMERGENCY - 10%
• BP > 30% increased for age and sex
• Evidence of encephalopathy
• Heart failure or pulmonary edema

AZOTEMIA: Varying degrees

 CLINICAL FEATURES
CIRCULATORY CONGESTION - 20%
• Dyspnea, orthopnea
• Cough, tachycardia, gallop rhythm
• Basal crepitations, pulmonary edema
 ATYPICAL PRESENTATION
• Pulmonary edema
• Congestive cardiac failure
• Hypertensive encephalopathy
• Renal failure
• Nephrotic syndrome
 DIAGNOSIS
URINALYSIS
• Dysmorphic or crenated RBC and RBC cast
• Moderate proteinuria, 5-10 % nephrotic range
• Leukocyte/ granular / hyaline casts
 DIAGNOSIS
BLOOD
• Mild normochromic anemia
• Transient elevation of urea and creatinine
• Reduced C3 level
• ASO titers elevated 1-5 weeks after infection in 80% four fold
rise
 INVESTIGATIONS FOR ETIOLOGIC
FACTORS

Culture of organisms in throat or skin

• Increased in pharyngeal infection: ASO titer
• Best single antibody titer to cutaneous infections: anti
DNAase B