Acute poststreptococcal glomerulonephritis

Suggested Alternatives for Differential Diagnosis Acute poststreptococcal glomerulonephritis, spotted fevers, typhus, malaria, hepatitis, Colorado tick fever, septicemia, heat stroke, disseminated intravascular coagulation, leptospirosis, hemolytic uremic syndrome. 

Serum complement levels are useful to distinguish between various forms of acute nephritis that may be due to either a primary renal disorder or a systemic disease. Glomerular diseases associated with decreased complement levels include systemic diseases such as systemic lupus erythematosus, subacute bacterial endocarditis, and cryoglobulinemia, and renal diseases such as acute poststreptococcal glomerulonephritis. Glomerular diseases in which serum complement levels are normal include systemic diseases such as Goodpasture s syndrome and renal diseases such as IgG-IgA nephropathy, antiglomerular basement membrane disease, and immune-complex disease. 

Several disease states can alter complement concentrations. Complement concentrations frequently are found to be lower than normal during states of acute inflammation. Low complement concentrations often are associated with systemic lupus erythematosus, rheumatoid arthritis, collagen-vascular disorders, poststreptococcal glomerulonephritis, and subacute bacterial endocarditis. These states of apparent low complement concentrations generally are due to high rates of complement utilization that cannot be compensated for by increased complement synthesis. ... 

Pharyngitis is the most common disease produced by S. pyogenes. Penicillin-resistant isolates of this organism have yet to be observed. The preferred oral therapy is with penicillin V, 500 mg every 6 hours for 10 days. Equal results are produced by the administration of 600,000 units of penicillin G procaine intramuscularly once daily for 10 days or by a single injection of 1.2 million units of penicillin G benzathine. Parenteral therapy is preferred if there are questions of patient compliance. Penicillin therapy of streptococcal pharyngitis reduces the risk of subsequent acute rheumatic fever but not of poststreptococcal glomerulonephritis. 

Soylu, A., et al.. Posterior leukoencephalopathy syndrome in poststreptococcal acute glomerulonephritis. Pediatr Nephrol, 2001. 16(7) p. 601-3. 

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