Post-streptococcal glomerulonephritis natural history, complications and prognosis: Difference between revisions
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{{Post-streptococcal glomerulonephritis}} | {{Post-streptococcal glomerulonephritis}} | ||
{{CMG}} {{AE}} {{MKK}} | |||
==Overview== | ==Overview== | ||
The symptoms of post-streptococcal [[glomerulonephritis]] typically develop one to three weeks after exposure to [[Group A streptococcal infection|group A streptococcal]] throat infection and 3 to 6 weeks after [[Group A streptococcal infection|group A streptococcal]] skin infection. Common complications of [[post-streptococcal glomerulonephritis]] include severe [[nephritis]], renal failure , atypical [[hemolytic-uremic syndrome|hemolytic uremic syndrome ,]] refractory hypoxic [[respiratory failure]], and [[seizure|seizures]]. Prognosis is generally excellent but depends upon age and co-morbidities. | |||
Common complications of [ | |||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*The symptoms of post-streptococcal glomerulonephritis typically develop one to three weeks after exposure to group A streptococcal | *The symptoms of post-streptococcal [[glomerulonephritis]] typically develop one to three weeks after exposure to [[Group A streptococcal infection|group A streptococcal]] throat infection and 3 to 6 weeks after [[Group A streptococcal infection|group A streptococcal]] skin infection. | ||
*If left untreated, patients with post-streptococcal glomerulonephritis may progress to develop renal failure.<ref name="pmid27642522">{{cite journal |vauthors=Ayoob RM, Schwaderer AL |title=Acute Kidney Injury and Atypical Features during Pediatric Poststreptococcal Glomerulonephritis |journal=Int J Nephrol |volume=2016 |issue= |pages=5163065 |date=2016 |pmid=27642522 |pmc=5011525 |doi=10.1155/2016/5163065 |url=}}</ref> | *If left untreated, patients with [[post-streptococcal glomerulonephritis]] may progress to develop [[renal failure]].<ref name="pmid27642522">{{cite journal |vauthors=Ayoob RM, Schwaderer AL |title=Acute Kidney Injury and Atypical Features during Pediatric Poststreptococcal Glomerulonephritis |journal=Int J Nephrol |volume=2016 |issue= |pages=5163065 |date=2016 |pmid=27642522 |pmc=5011525 |doi=10.1155/2016/5163065 |url=}}</ref> | ||
===Complications=== | ===Complications=== | ||
Common complications of post-streptococcal glomerulonephritis include:<ref name="pmid26798467">{{cite journal |vauthors=Kakajiwala A, Bhatti T, Kaplan BS, Ruebner RL, Copelovitch L |title=Post-streptococcal glomerulonephritis associated with atypical hemolytic uremic syndrome: to treat or not to treat with eculizumab? |journal=Clin Kidney J |volume=9 |issue=1 |pages=90–6 |date=February 2016 |pmid=26798467 |pmc=4720198 |doi=10.1093/ckj/sfv119 |url=}}</ref><ref name="pmid27231692">{{cite journal |vauthors=Mara-Koosham G, Stoltze K, Aday J, Rendon P |title=Pulmonary Renal Syndrome After Streptococcal Pharyngitis: A Case Report |journal=J Investig Med High Impact Case Rep |volume=4 |issue=2 |pages=2324709616646127 |date=2016 |pmid=27231692 |pmc=4871206 |doi=10.1177/2324709616646127 |url=}}</ref><ref name="pmid25218027">{{cite journal |vauthors=Adikari M, Priyangika D, Marasingha I, Thamotheram S, Premawansa G |title=Post-streptococcal glomerulonephritis leading to posterior reversible encephalopathy syndrome: a case report |journal=BMC Res Notes |volume=7 |issue= |pages=644 |date=September 2014 |pmid=25218027 |pmc=4175190 |doi=10.1186/1756-0500-7-644 |url=}}</ref> | Common complications of [[post-streptococcal glomerulonephritis]] include:<ref name="pmid26798467">{{cite journal |vauthors=Kakajiwala A, Bhatti T, Kaplan BS, Ruebner RL, Copelovitch L |title=Post-streptococcal glomerulonephritis associated with atypical hemolytic uremic syndrome: to treat or not to treat with eculizumab? |journal=Clin Kidney J |volume=9 |issue=1 |pages=90–6 |date=February 2016 |pmid=26798467 |pmc=4720198 |doi=10.1093/ckj/sfv119 |url=}}</ref><ref name="pmid27231692">{{cite journal |vauthors=Mara-Koosham G, Stoltze K, Aday J, Rendon P |title=Pulmonary Renal Syndrome After Streptococcal Pharyngitis: A Case Report |journal=J Investig Med High Impact Case Rep |volume=4 |issue=2 |pages=2324709616646127 |date=2016 |pmid=27231692 |pmc=4871206 |doi=10.1177/2324709616646127 |url=}}</ref><ref name="pmid25218027">{{cite journal |vauthors=Adikari M, Priyangika D, Marasingha I, Thamotheram S, Premawansa G |title=Post-streptococcal glomerulonephritis leading to posterior reversible encephalopathy syndrome: a case report |journal=BMC Res Notes |volume=7 |issue= |pages=644 |date=September 2014 |pmid=25218027 |pmc=4175190 |doi=10.1186/1756-0500-7-644 |url=}}</ref> | ||
*Severe nephritis | *Severe [[nephritis]] | ||
*Renal failure | *[[Renal failure]] | ||
*Atypical hemolytic | *Atypical [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]] | ||
*Refractory hypoxic respiratory failure | *Refractory hypoxic [[respiratory failure]] | ||
*Seizures | *[[Seizure|Seizures]] | ||
===Prognosis=== | ===Prognosis=== | ||
*Prognosis is generally excellent.<ref name="pmid18667731">{{cite journal |vauthors=Rodriguez-Iturbe B, Musser JM |title=The current state of poststreptococcal glomerulonephritis |journal=J. Am. Soc. Nephrol. |volume=19 |issue=10 |pages=1855–64 |date=October 2008 |pmid=18667731 |doi=10.1681/ASN.2008010092 |url=}}</ref><ref name="pmid2191230">{{cite journal |vauthors=Tejani A, Ingulli E |title=Poststreptococcal glomerulonephritis. Current clinical and pathologic concepts |journal=Nephron |volume=55 |issue=1 |pages=1–5 |date=1990 |pmid=2191230 |doi=10.1159/000185909 |url=}}</ref> | *Prognosis is generally excellent.<ref name="pmid18667731">{{cite journal |vauthors=Rodriguez-Iturbe B, Musser JM |title=The current state of poststreptococcal glomerulonephritis |journal=J. Am. Soc. Nephrol. |volume=19 |issue=10 |pages=1855–64 |date=October 2008 |pmid=18667731 |doi=10.1681/ASN.2008010092 |url=}}</ref><ref name="pmid2191230">{{cite journal |vauthors=Tejani A, Ingulli E |title=Poststreptococcal glomerulonephritis. Current clinical and pathologic concepts |journal=Nephron |volume=55 |issue=1 |pages=1–5 |date=1990 |pmid=2191230 |doi=10.1159/000185909 |url=}}</ref> | ||
*Some people develop recurrent proteinuria and renal dysfunction 10 to 40 years after the presentation.<ref name="pmid11479149">{{cite journal |vauthors=Pinto SW, Sesso R, Vasconcelos E, Watanabe YJ, Pansute AM |title=Follow-up of patients with epidemic poststreptococcal glomerulonephritis |journal=Am. J. Kidney Dis. |volume=38 |issue=2 |pages=249–55 |date=August 2001 |pmid=11479149 |doi=10.1053/ajkd.2001.26083 |url=}}</ref> | *Some people develop recurrent [[proteinuria]] and [[renal dysfunction]] 10 to 40 years after the presentation.<ref name="pmid11479149">{{cite journal |vauthors=Pinto SW, Sesso R, Vasconcelos E, Watanabe YJ, Pansute AM |title=Follow-up of patients with epidemic poststreptococcal glomerulonephritis |journal=Am. J. Kidney Dis. |volume=38 |issue=2 |pages=249–55 |date=August 2001 |pmid=11479149 |doi=10.1053/ajkd.2001.26083 |url=}}</ref> | ||
*Age and presence of comorbidities are the most important prognostic factors for PSGN. | |||
*Children have an excellent prognosis with a <1% rate of azotemia, and a 3-10% rate of non-nephrotic range proteinuria, microhematuria, and hypertension. | |||
*The prognosis of PSGN in children might vary depending on individual co-morbidities, such as diabetes, obesity, and low birth weight.<ref name="pmid18667731">{{cite journal| author=Rodriguez-Iturbe B, Musser JM| title=The current state of poststreptococcal glomerulonephritis. | journal=J Am Soc Nephrol | year= 2008 | volume= 19 | issue= 10 | pages= 1855-64 | pmid=18667731 | doi=10.1681/ASN.2008010092 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18667731 }} </ref> | |||
*Elderly patients with PSGN who often have co-morbidities have a comparatively much poorer prognosis with a 60% rate of azotemia, 40% rate of congestive heart failure, and 20% rate of nephrotic syndrome.<ref name="pmid3631152">{{cite journal| author=Melby PC, Musick WD, Luger AM, Khanna R| title=Poststreptococcal glomerulonephritis in the elderly. Report of a case and review of the literature. | journal=Am J Nephrol | year= 1987 | volume= 7 | issue= 3 | pages= 235-40 | pmid=3631152 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3631152 }} </ref><ref name="pmid8050205">{{cite journal| author=Washio M, Oh Y, Okuda S, Yanase T, Miishima C, Fujimi S et al.| title=Clinicopathological study of poststreptococcal glomerulonephritis in the elderly. | journal=Clin Nephrol | year= 1994 | volume= 41 | issue= 5 | pages= 265-70 | pmid=8050205 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8050205 }} </ref> | |||
==References== | ==References== |
Latest revision as of 17:40, 14 June 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
The symptoms of post-streptococcal glomerulonephritis typically develop one to three weeks after exposure to group A streptococcal throat infection and 3 to 6 weeks after group A streptococcal skin infection. Common complications of post-streptococcal glomerulonephritis include severe nephritis, renal failure , atypical hemolytic uremic syndrome , refractory hypoxic respiratory failure, and seizures. Prognosis is generally excellent but depends upon age and co-morbidities.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of post-streptococcal glomerulonephritis typically develop one to three weeks after exposure to group A streptococcal throat infection and 3 to 6 weeks after group A streptococcal skin infection.
- If left untreated, patients with post-streptococcal glomerulonephritis may progress to develop renal failure.[1]
Complications
Common complications of post-streptococcal glomerulonephritis include:[2][3][4]
- Severe nephritis
- Renal failure
- Atypical hemolytic uremic syndrome
- Refractory hypoxic respiratory failure
- Seizures
Prognosis
- Prognosis is generally excellent.[5][6]
- Some people develop recurrent proteinuria and renal dysfunction 10 to 40 years after the presentation.[7]
- Age and presence of comorbidities are the most important prognostic factors for PSGN.
- Children have an excellent prognosis with a <1% rate of azotemia, and a 3-10% rate of non-nephrotic range proteinuria, microhematuria, and hypertension.
- The prognosis of PSGN in children might vary depending on individual co-morbidities, such as diabetes, obesity, and low birth weight.[5]
- Elderly patients with PSGN who often have co-morbidities have a comparatively much poorer prognosis with a 60% rate of azotemia, 40% rate of congestive heart failure, and 20% rate of nephrotic syndrome.[8][9]
References
- ↑ Ayoob RM, Schwaderer AL (2016). "Acute Kidney Injury and Atypical Features during Pediatric Poststreptococcal Glomerulonephritis". Int J Nephrol. 2016: 5163065. doi:10.1155/2016/5163065. PMC 5011525. PMID 27642522.
- ↑ Kakajiwala A, Bhatti T, Kaplan BS, Ruebner RL, Copelovitch L (February 2016). "Post-streptococcal glomerulonephritis associated with atypical hemolytic uremic syndrome: to treat or not to treat with eculizumab?". Clin Kidney J. 9 (1): 90–6. doi:10.1093/ckj/sfv119. PMC 4720198. PMID 26798467.
- ↑ Mara-Koosham G, Stoltze K, Aday J, Rendon P (2016). "Pulmonary Renal Syndrome After Streptococcal Pharyngitis: A Case Report". J Investig Med High Impact Case Rep. 4 (2): 2324709616646127. doi:10.1177/2324709616646127. PMC 4871206. PMID 27231692.
- ↑ Adikari M, Priyangika D, Marasingha I, Thamotheram S, Premawansa G (September 2014). "Post-streptococcal glomerulonephritis leading to posterior reversible encephalopathy syndrome: a case report". BMC Res Notes. 7: 644. doi:10.1186/1756-0500-7-644. PMC 4175190. PMID 25218027.
- ↑ 5.0 5.1 Rodriguez-Iturbe B, Musser JM (October 2008). "The current state of poststreptococcal glomerulonephritis". J. Am. Soc. Nephrol. 19 (10): 1855–64. doi:10.1681/ASN.2008010092. PMID 18667731.
- ↑ Tejani A, Ingulli E (1990). "Poststreptococcal glomerulonephritis. Current clinical and pathologic concepts". Nephron. 55 (1): 1–5. doi:10.1159/000185909. PMID 2191230.
- ↑ Pinto SW, Sesso R, Vasconcelos E, Watanabe YJ, Pansute AM (August 2001). "Follow-up of patients with epidemic poststreptococcal glomerulonephritis". Am. J. Kidney Dis. 38 (2): 249–55. doi:10.1053/ajkd.2001.26083. PMID 11479149.
- ↑ Melby PC, Musick WD, Luger AM, Khanna R (1987). "Poststreptococcal glomerulonephritis in the elderly. Report of a case and review of the literature". Am J Nephrol. 7 (3): 235–40. PMID 3631152.
- ↑ Washio M, Oh Y, Okuda S, Yanase T, Miishima C, Fujimi S; et al. (1994). "Clinicopathological study of poststreptococcal glomerulonephritis in the elderly". Clin Nephrol. 41 (5): 265–70. PMID 8050205.