Nephrology

	Answer 2 Diuretics and antihypertensive medication. This patient has acute poststreptococcal glomerulonephritis, an immune complex-mediated glomerulonephritis usually seen in children but also found in adults. Antibodies that form against streptococcal antigens localize on the glomerular capillary wall and activate the complement system, initiating an inflammatory response. Symptoms typically develop a few days to weeks after a pharyngeal or skin infection with nephritogenic strains of group A ß-hemolytic streptococci. If clinical features typical for acute poststreptococcal glomerulonephritis (eg, hematuria, red blood cell casts, proteinuria [< 3 g] on urinalysis) are present with reduced total complement activity and C3 levels as well as evidence of prior streptococcal infection, biopsy is not required. Management of patients with acute poststreptococcal glomerulonephritis is generally supportive with diuretics and salt restriction to control edema and antihypertensive therapy to control blood pressure.2 The disease presents once acute infection has already resolved; therefore, antibiotics to treat group A streptococcal infection are not usually necessary unless symptoms of active infection are still present. There is no evidence that immunosuppressive therapy with steroids is beneficial. The majority of children recover spontaneously, even those presenting with severe acute kidney injury. Prognosis is excellent with recovery of renal function in 6 weeks and serum complement levels returning to normal in 6 to 12 weeks. Persistently low complement levels should prompt evaluation for another cause of glomerulonephritis or systemic lupus erythematosus nephritis. Asymptomatic urinary abnormalities such as microscopic hematuria and proteinuria may persist for up to 2 years from the acute presentation. Recurrence of acute poststreptococcal glomerulonephritis is rare. REFERENCE 2. Roy S 3rd, Murphy WM, Arant BS Jr. Poststreptococcal crescenteric glomerulonephritis in children: comparison of quintuple therapy versus supportive care. J Pediatr 1981;98:403–10. Click here to return to the questions
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