A 10-year-old boy presents with Coca-Cola-colored urine and edema of his lower extremities. On physical examination the patient has a blood pressure of 185/100. He does not appear to be in any distress. His lungs are clear to auscultation, and his heart has a regular rate and rhythm without any murmurs, gallops, or rubs. His past medical history is remarkable for a sore throat that was presumed viral by his physician 2 weeks before.
Definition. Acute poststreptococcal glomerulonephritis follows infection of the throat or skin with "nephritogenic" strains of group A P-hemolytic streptococci.
Risk Factors/Etiology. This problem may manifest 1-2 weeks after a streptococcal infection of the throat or skin (impetigo). This illness is seen commonly in children but is rare before 3 years of age.
Presentation. Acute glomerulonephritis follows infection with nephritogenic group A (3-hemolyt-ic streptococci by 1 to 2 weeks. The patient may exhibit gross hematuria, edema, hypertension, and renal insufficiency. The severity of the illness varies with the patient.
Patients may also complain of fever, malaise, and abdominal or flank pain.
Diagnostic Tests. Red blood cell casts and protein may be found on urinalysis. There should be evidence of a past infection with group A (3-hemolytic streptococcus. The best method for determining this is the deoxyribonuclease (DNase) B antigen. In addition, the patient may have mild anemia and a decreased serum C3. An antinuclear antibodies (ANA) test may be obtained to rule out systemic lupus erythematosus. A renal biopsy is usually not needed in classic cases (acute nephritic syndrome plus evidence of streptococcal infection plus low C3 level).
Treatment. Antibiotics may be given to curtail the spread of the nephritogenic strain; however, there is no evidence to demonstrate that they will eliminate the risks or change the natural course of the disease. Antihypertensive medications should be used for hypertension. If present, renal failure should be treated promptly to avoid morbidity and mortality.
Complications/Follow-up. The patient may experience hypertension and acute renal failure. Some other problems include seizures, hyperkalemia, and hypocalcemia. However, 95% of patients with acute poststreptococcal glomerulonephritis will have complete recovery.
Differential Diagnosis. Systemic lupus erythematosus should be considered in the differential diagnosis and an ANA may be obtained to rule it out. Entities that cause hematuria (hemolytic uremic syndrome, membranous glomerulopathy, etc.) should also be considered in the differential diagnosis.
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