What is Post-Streptococcal Glomerulonephritis?

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post-streptococcal glomerulonephritis

Post-streptococcal glomerulonephritis (PSGN) is a disease of the kidneys which occurs after infection with certain strains of a bacterium called group A streptococcus (GAS).^[1] Streptococcal bacteria can cause many different conditions. Symptoms of these conditions often affect the skin and throat, such as scarlet fever and tonsillitis.^[2]

The most common symptom of PSGN is swelling around the eyes.^[3] This swelling can also affect other parts of the body, such as the hands and feet. Dark or rusty-colored urine is a possible early sign of the condition.^[4] However, approximately half of people affected by PSGN will display no symptoms.

PSGN is a knock-on effect of the infection in the kidneys. As a response to the infection, blood vessels in the kidneys become inflamed. This makes it harder for the kidneys to filter urine.^[5]

The disease is now very rare in high-income countries such as the U.S. and the U.K. Children are the age group most affected by the condition worldwide, but when it does occur in high-income countries such as the U.S., it is usually the elderly that are most affected.^[6]

PSGN usually resolves itself after a few weeks or months. Treatment is directed at controlling symptoms through medication and removing any infection left in the body with antibiotics such as penicillin.^[5] A low-salt diet may be recommended to control swelling.

The vast majority of people affected by PSGN will recover with no complications. However, in rare cases, the condition can lead to long-term kidney damage, such as kidney failure. This is far more common in adults than in children.^[1][4]

Symptoms

The severity of symptoms varies from person to person. Approximately half of the people affected by PSGN display no signs of the illness.^[3] When symptoms do occur, it is usually between seven and 21 days after the group A streptococcal infection begins.

The most common effect of the condition is swelling that begins around the eyes.^[3] The swelling can sometimes affect other parts of the body, notably the hands and feet.^[5]

Another symptom of the condition is dark-colored urine, sometimes described as rust-colored or cola-colored. This dark coloration is due to blood being present in the urine.^[3]

High blood pressure, also known as hypertension, is a common effect of PSGN. However, this can often cause no observable symptoms.

Other potential symptoms include:^[1][4][3]

• Less need to urinate than usual
• Protein in the urine. This may not be visible, but, when it is, the urine has a frothy appearance
• Increased tiredness, due to anemia
• Abdominal pain
• A loss of appetite
• Fever
• Headache

If you are experiencing possible symptoms of post-streptococcal glomerulonephritis, try using a List of Doctors to carry out a symptom assessment.

Causes

The kidneys are two organs that sit underneath the ribs in the back of the abdomen and that are responsible for filtering toxins from the blood. If the small filtration units of the kidney, known as the glomeruli, become inflamed and swollen, this is called glomerulonephritis. There are several other possible causes for this, besides infection with GAS bacteria. These include autoimmune disorders – when the immune system mistakenly begins to attack the healthy body tissues – and various other medical conditions, including diabetes and some cancers.

PSGN is not an infection and is thought to be the immune system’s reaction to the GAS infection. In other words, PSGN itself cannot be caught by other people.^[4]

Most group A streptococcal infections that lead to PSGN primarily affect the skin or the throat. These include:^[2]

• Pharyngitis
• Tonsillitis
• Scarlet fever
• Impetigo
• Erysipelas
• Cellulitis
• Pneumonia

Children between two and 12 are the age group most at risk of developing PSGN. Six or seven years old is the age when the infection is most likely. Males are more likely to be affected than females, and the condition often occurs after a large outbreak of an infection, otherwise known as an epidemic.^[6]

PSGN is most common in tropical countries where skin infections are a regular occurrence. PSGN is now very rare in high-income countries such as the U.S. and the U.K. In these countries, it primarily affects those over 50, particularly men. The following are risk factors for developing the condition later in life:^[1][6]

• Diabetes mellitus
• High consumption of alcohol
• HIV infection
• Tumors and cancers

Diagnosis

The diagnosis may be suspected based on the symptoms affecting a person who has recently been unwell with a bacterial infection. Several tests may be carried out to help with the diagnosis, including blood tests and urine tests for the following purposes:^[5][7]

• To help confirm the diagnosis of PSGN
• To check on how well the kidney is functioning
• To find out if the group A streptococcal infection is still present

An ultrasound, which is when sound waves are used to create an image inside of the body, may be carried out on the kidney. The organ is often visible in ultrasound as slightly enlarged in people affected by PSGN.^[7]

In rare cases – usually where a person is not showing the typical signs of PSGN, or if serious complications are suspected – a kidney biopsy may be recommended. This is when a special needle is used to remove a few very small pieces of the kidney so that they can be laboratory tested.^[7]

Treatment

PSGN usually resolves itself in a few weeks or months.^[5] By the time post-streptococcal glomerulonephritis is diagnosed in most children, the body has already begun to recover from the inflammation.^[8]. Medication and lifestyle changes can give some relief from the symptoms and address any complications that the condition may cause.

Diet and exercise

One of the first recommendations a doctor may give will usually be to restrict salt in the diet and to drink less water.^[1] Temporarily eating less protein, i.e. cutting out meat and plant-based protein products, may be recommended.^[8]

Medication

Penicillin may be recommended if there is any remaining evidence of group A streptococcal infection. Erythromycin may be given instead of the person affected being allergic to penicillin.^[8]

Loop diuretics, which increase urine production, may be recommended to reduce swelling and control blood pressure.^[5] Other blood pressure medications, including angiotensin-converting enzyme inhibitors and calcium-channel blockers, may also be used as part of treatment for PSGN.^[8]

Prevention

The best means of preventing PSGN is to prevent the spread of group A streptococcal infection. At present, there is no vaccine available to prevent group A streptococcal infection.^[9] As a result, practicing good hygiene and ensuring that anybody affected by GAS or PSGN is treated are the best ways to prevent the condition. This includes:^[10]

• Washing the hands thoroughly before eating or preparing food
• Covering the mouth or nose before coughing or sneezing
• Staying at home until after being treated with antibiotics for GAS infection or until after fever stops completely

Complications

Most people affected by PSGN recover in a few weeks. However, several possible complications may occur because of the condition. These complications are generally more common in adults than in children. They include:^[5][11]

• High blood pressure, also known as hypertension
• Renal failure
• Anemia
• Pulmonary edema, a buildup of fluid in the lungs
• Hyperkalemia, an abnormally high level of potassium in the blood

Heart failure is a rare, but possible complication of PSGN.

FAQs about ost-Streptococcal Glomerulonephritis

Other names for post-streptococcal Glomerulonephritis

• Poststreptococcal glomerulonephritis
• Postinfectious glomerulonephritis

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1. “Post-Streptococcal Glomerulonephritis.” Streptococcus pyogenes : Basic Biology to Clinical Manifestations. 10 February, 2016. Accessed: 28 January, 2019. ↩ ↩ ↩ ↩ ↩

2. “Group A streptococcal infections: guidance and data.” Public Health England. 13 February, 2018. Accessed: 28 January, 2019. ↩ ↩

3. “Acute Poststreptococcal Glomerulonephritis Clinical Presentation: Presentation.” Medscape. 05 December, 2018. Accessed: 28 January, 2019. ↩ ↩ ↩ ↩ ↩

4. “Post-Streptococcal Glomerulonephritis: All You Need to Know.” Centers for Disease Control and Prevention. 01 November, 2018. Accessed: 28 January, 2019. ↩ ↩ ↩ ↩

5. “Poststreptococcal glomerulonephritis (GN).” MedlinePlus. 08 January, 2017. Accessed: 28 January, 2019. ↩ ↩ ↩ ↩ ↩ ↩ ↩

6. “Acute Poststreptococcal Glomerulonephritis: Epidemiology.” Medscape. 05 December, 2018. Accessed: 28 January, 2019. ↩ ↩ ↩

7. “Acute Poststreptococcal Glomerulonephritis Workup.” Medscape. 05 December, 2018. Accessed: 28 January, 2019. ↩ ↩ ↩

8. “Acute Poststreptococcal Glomerulonephritis Treatment & Management: Approach Considerations.” Medscape. 05 December, 2018. Accessed: 28 January, 2019. ↩ ↩ ↩ ↩

9. “Current Approaches to Group A Streptococcal Vaccine Development.” Streptococcus pyogenes : Basic Biology to Clinical Manifestations. 10 February, 2016. Accessed: 08 February, 2019. ↩

10. “Post-Streptococcal Glomerulonephritis.” Centers for Disease Control and Prevention. 01 November, 2018. Accessed: 08 February, 2019. ↩

11. “Acute Poststreptococcal Glomerulonephritis: Prognosis.” 05 December, 2018. Accessed: 08 February, 2019. ↩

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**What is Post-Streptococcal Glomerulonephritis?**



**Definition:**



Post-streptococcal glomerulonephritis (PSGN) is an immune-mediated kidney disease that develops‌ after a recent streptococcal infection, typically after a streptococcal⁤ skin infection (impetigo) or a⁤ streptococcal throat⁣ infection ​(pharyngitis).



**How PSGN Develops:**



After a streptococcal infection, some individuals‌ develop abnormal antibodies called anti-streptolysin O (ASO) antibodies. These antibodies mistakenly attack the glomeruli, the ​tiny filters in the ⁣kidneys, causing inflammation and damage.



**Symptoms:**



* Swelling in the face, hands, and feet

* Blood⁤ in the urine (hematuria)

* Dark urine (increased urine concentration‍ due to less water filtration)

*‌ Decreased urine output

* High blood pressure

* ⁣Fatigue

* Nausea and vomiting

* Headache



**Causes:**



The exact cause of PSGN​ is unknown, but it‍ is believed to be related to an abnormal immune response to ‍streptococcal antigens (substances present on‍ the streptococcus⁢ bacteria).



**Risk Factors:**



* Infection with a ‍specific strain of⁢ Streptococcus pyogenes bacteria

* Recent ⁣streptococcal skin or throat infection

* Certain immune system ⁤conditions or genetic factors



**Diagnosis:**



* Physical examination and medical ⁤history

*⁢ Blood tests to detect⁢ elevated ​ASO antibody levels

* Urine⁤ tests to assess kidney function and detect blood or protein ​in⁤ the ⁢urine

* Kidney biopsy may be recommended in severe or ⁤persistent cases



**Treatment:**



Treatment‍ focuses on managing the inflammation and preventing further kidney damage:



* **Antibiotics:** To treat the underlying‍ streptococcal infection

* **Corticosteroids:** To reduce inflammation

* **Other Medications:** May include antihypertensives for high blood pressure ‍and diuretics to reduce fluid retention

* **Dialysis:** May be necessary in severe cases or if kidney failure develops



**Prevention:**



Prevention of ‌streptococcal infections is key in reducing the risk⁣ of PSGN. This includes:



* Proper ⁣hand hygiene

*​ Covering‌ open wounds

* Avoiding contact with ⁤people who have streptococcal ‌infections

* Getting vaccinated‌ against streptococcal pneumonia



**Complications:**



Untreated or severe‌ PSGN can lead to complications such as:



* ​Permanent⁣ kidney ‍damage

* Kidney failure

* High blood⁢ pressure

* Fluid retention

* Electrolyte imbalances



**Outlook:**



With prompt diagnosis and treatment, most people with PSGN recover ‌fully. However, a small percentage may develop chronic ‌kidney disease or​ other complications. Regular monitoring and proper ‌streptococcal infection ⁢prevention are important to‍ minimize the risk of recurrence.