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Poststreptococcal glomerulonephritis - Coggle Diagram
Poststreptococcal glomerulonephritis
DEFINITION
Is a disease caused by prior infection with specific nephritogenic strains of group A beta-hemolytic streptococcus.
PATHOLOGY
Light microscopy
Diffuse proliferative and exudative glomerulonephritis
Prominent endocapillary proliferation and numerous neutrophils
Immunofluorescence microscopy
Characteristic pattern of deposits of C3 and immunoglobulin G (IgG)
Diffuse granular pattern within the mesangium and glomerular capillary walls
Electron microscopy
Dome-shaped subepithelial electron-dense deposits that are referred to as humps
CLINICAL MANIFESTATIONS
Clinical presentation
Asymptomatic, microscopic hematuria
Most children
Acute nephritic syndrome
Most common presenting signs in children
Edema
Gross hematuria
Hypertension
Laboratory findings
Decline in glomerular filtration rate
Hematuria with or without red blood cell casts
C3 and CH50 (total complement activity)
are significantly depressed in the first two weeks of the disease course
Positive throat or skin culture
Elevated titers of antibodies to extracellular streptococcal products
DIAGNOSIS
Acute nephritis
Positive throat or skin culture or
serologic tests
DIFFERENTIAL DIAGNOSIS
C3 glomerulopathy
IgA nephropathy
Lupus nephritis and IgA vasculitis
Hepatitis B and endocarditis-associated glomerulonephritis
Postinfectious GN due to other microbial agents
PROGNOSIS
Most patients, particularly children, have an excellent outcome
Some patients, particularly adults develop renal
insufficiency as long as 10 to 40 years after the initial illness
Some patients can also develop hypertension, recurrent proteinuria
Late renal complications are associated with glomerulosclerosis on renal biopsy
EPIDEMIOLOGY
97 percent occur in regions of the world with poor socioeconomic status
It primarily occurs in developing countries
It´s the most common cause of acute nephritis in children globally
The risk is increased in older patients (greater than 60 years of age) and in children between 5
and 12 years of age
PATHOGENESIS
Autoimmune reactivity
In situ immune complex formation resulting from deposition of streptococcal antigens within the
glomerular basement membrane (GBM) and subsequent antibody binding.
Deposition of circulating immune complexes with streptococcal antigenic components
Nephritogenic antigens
Receptor (NAPlr)
Exotoxin B (SPE B)
ACUTE MANAGEMENT
Dialysis
Indications for referral
Fluid overload that is unresponsive or slow to respond to supportive measures
Refractory hypertension
Evidence of serious renal function compromise
Supportive care
Antibiotic therapy
Penicillin
Renal biopsy