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    Post-streptococcal glomerulonephritis (GN)

    Glomerulonephritis - post-streptococcal; Post-infectious glomerulonephritis

    Post-streptococcal glomerulonephritis (GN) is a disorder of the kidneys that occurs after infection with certain strains of Streptococcus bacteria.

    Causes

    Post-streptococcal GN is a form of glomerulonephritis. It is caused by an infection with a type of streptococcus bacteria. The infection does not occur in the kidneys, but in a different part of the body, such as the skin or throat.

    The strep bacterial infection causes the tiny blood vessels in the filtering units of the kidneys (glomeruli) to become inflamed. This makes the kidneys less able to filter the urine.

    Post-streptococcal GN is uncommon today because infections that can lead to the disorder are commonly treated with antibiotics. The disorder may develop 1 - 2 weeks after an untreated throat infection, or 3 - 4 weeks after a skin infection.

    It may occur in people of any age, but it most often occurs in children ages 6 - 10. Although skin and throat infections are common in children, post-streptococcal glomerulonephritis is a rare complication of these infections.

    Risk factors include:

    • Strep throat
    • Streptococcal skin infections (such as impetigo)

    Symptoms

    • Decreased urine output
    • Rust-colored urine
    • Swelling (edema), general swelling, swelling of the abdomen, swelling of the face or eyes, swelling of the feet, ankles, hands
    • Visible blood in the urine

    Other symptoms that may occur with this disease:

    Exams and Tests

    A physical examination shows swelling (edema), especially in the face. Abnormal sounds may be heard when listening to the heart and lungs with a stethoscope (auscultation). Blood pressure is often high.

    Other tests that may be done include:

    • Anti-DNase B
    • Kidney biopsy (this is usually not needed)
    • Serum ASO (and streptolysin O)
    • Serum complement levels
    • Urinalysis

    Treatment

    There is no specific treatment for post-streptococcal glomerulonephritis. Treatment is focused on relieving symptoms.

    • Antibiotics, such as penicillin, should be used to destroy any streptococcal bacteria that remain in the body.
    • Blood pressure medications and diuretic medications may be needed to control swelling and high blood pressure.
    • Corticosteroids and other anti-inflammatory medications are generally not effective.

    You may need to limit salt in the diet to control swelling and high blood pressure.

    Outlook (Prognosis)

    Post-streptococcal glomerulonephritis usually goes away by itself after several weeks to months.

    In small number of adults, it may get worse and lead to chronic kidney failure. Sometimes it can progress to end-stage kidney disease, which requires dialysis and a kidney transplant.

    • Acute renal failure
    • Chronic glomerulonephritis
    • Chronic renal disease
    • Congestive heart failure or pulmonary edema
    • End-stage renal disease
    • Hyperkalemia
    • High blood pressure (hypertension)
    • Nephrotic syndrome

    When to Contact a Medical Professional

    Call your health care provider if:

    • You have symptoms of post-streptococcal GN
    • You have post-streptococcal GN, and you have decreased urine output or other new symptoms

    Prevention

    Treating known streptococcal infections may prevent post-streptococcal GN.

    References

    Appel GB. Glomerular disorders and nephrotic syndromes. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 122.

    Nachman PH, Jennette JC, Falk RJ. Primary glomerular disease. In: Brenner BM, ed. Brenner and Rector's the Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 30.

    Pan Cg, Avner Ed. Glomerulonephritis associated with infections. In: Kliegman RM, Stanton BF, St. Geme JW III, Schor NF, Behrman RE, eds. Nelson's Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 505.

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    • Kidney anatomy

      illustration

      • Kidney anatomy

        illustration

      Self Care

        Tests for Post-streptococcal glomerulonephritis (GN)

          Review Date: 9/8/2013

          Reviewed By: Charles Silberberg, DO, Private Practice specializing in Nephrology, Affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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