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1. Poststreptococcal
Glomerulonephritis
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. Poststreptococcal GN (Introduction)
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Usually occurs 10 days
after pharyngitis and 14
days after skin infection
(not synpharyngitic)
Fallen incidence in US, but
common in some rural
areas, poor hygiene
places, and tropical
countries
Occurs more often in
males and children
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3. Poststreptoccal GN (nephritic strains)
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Known nephritic strains
include M types 1, 2, 4,
12, 18, 25, 49, 55, 57, 60
Many proposed
mechanisms: Molecular
mimickry vs. autoimmune
vs. polyclonal activation of
B lymphocytes
Repeat infections are not
common as immunity is
type specific and not
usually transient
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4. Clinical Presentation
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Most patients have milder disease
Classically, presents with overt nephritic
syndrome and oliguric ARF
Symptoms can include gross hematuria
(100% microscopic), HA, htn (60-80%),
hypervolemia, and edema (80-90%)
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5. Clinical Presentation
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Nephritic urinary
sediment –
dysmorphic RBCs, red
cell casts, leukocytes,
subnephrotic
proteinuria
Nephrotic-range
proteinuria not
common
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6. Labs
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Serum Cr can be commonly elevated at presentation, though
mild
C3 and CH50 decreased w/in 2 weeks
C4 usually normal (complement level usually normal within 68 weeks)
Most patients have directed Ab, such as ASO, anti-DNAse B,
etc
Serum IgG and IgM increased in 80% and returns to normal
in 1-2 months
Polyclonal cryoglobulinemia in 75%
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7. Light Microscopy
On light microscopy,
usually see diffuse
proliferative GN
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8. Immunofluorescence Microscopy
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Deposition of IgG and
C3
3 patterns
mesangial
Starry sky (mesangial
and capillary wall)
Garland (capillary loops)
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9. Electron Microscopy
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large electron – dense
immune deposits in
subendothelial,
subepithelial, and
mesangial areas
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10. Course
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Irreversible Renal Failure rare – less than 1 % in
children, slightly higher in adults
Resolution usually quick, plasma Cr usually
returns to previous levels by 3-4 weeks
Hematuria resolves usually within 3-6 months,
proteinuria falls at a slower rate
Some patients experience htn, recurrent
proteinuria, and renal insufficiency 10-40 yrs after
> 20% of adults may have some degree of
persistent proteinuria and or compromise of GFR
1 year out
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11. Treatment
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Eliminate strep infxn with abx
Supportive therapy
Diuretics and antihypertensives to control
bp and extracellular fluid volume
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12. Acute GN and Pulmonary Hemorrhage
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ANCA associated systemic vasculitis and antiGBM - common causes
Also reported to occur in SLE, HSP, mixed
Cryoglobulinemia
Study of 88 patients with Pulmonary Hemorrhage
and Nephritis: 48 ANCA, 6 Anti GBM, 7 both, 27
neither ANCA nor anti-GBM (latter group – not
many causes could explain both findings)
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13. The End
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