Poststreptococcal glomerulonephritis

The goals of therapy for streptococcal pharyngitis are to eradicate infection in order to prevent complications, shorten the disease course, and reduce infectivity and spread to close contacts. Sequelae that can be prevented by antibiotic use are peritonsillar or retropharyngeal abscess, cervical lymphadenitis, and rheumatic fever. There is no evidence that antibiotic use has an impact on the incidence of 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. 

Glomerular damage Accelerated hypertension Systemic lupus erythematosus Poststreptococcal glomerulonephritis Antiglomerular basement membrane disease... 

Ravnskov U. Exposure to organic solvents-a missing link in poststreptococcal glomerulonephritis Acta Med Scand 1978 203 ... 

Poststreptococcal glomerulonephritis Mesangiocapiliary glomerulonephritis Polymyalgia rheumatica, ... 

The treatment of poststreptococcal glomerulonephritis is mainly supportive and symptomatic. Antibiotic therapy does not prevent subsequent diseases, but may reduce the severity. 

Pinto SW, Sesso R, Vasconcelos E, et al. Follow-up of patients with epidemic poststreptococcal glomerulonephritis. Am J Kidney Dis 2001 38 249-255. 

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. ... 

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. 

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. 

The marked inflammatory changes in the glomerular capillaries that accompany poststreptococcal glomerulonephritis significantly reduce the flow of blood to the filtering surfaces of these vessels. As a result, creatinine, urea, and other circulating metabolites that are filtered into the urine at a normal rate (the glomerular filtration rate or GFR) in the absence of kidney disease now fail to reach the filters, and, therefore, they accumulate in the plasma. 

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

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