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Acute poststreptococcal glomerulonephritis ( APSGN) - Causes, Symptoms and Treatment

Definition:

Acute poststreptococcal glomerulonephritis (APSGN) is an inflammation of the kidney tubules (glomeruli) that filter waste products from the blood, following a streptococcal infection such as strep throat. APSGN is also called postinfectious glomerulonephritis.

Glomerulonephritis (GN) is the term generally reserved for the variety of renal diseases in which inflammation of the glomerulus, manifested by proliferation of cellular elements, is secondary to an immunologic mechanism. The modification of this term by the adjective acute (eg, acute glomerulonephritis [AGN], poststreptococcal acute glomerulonephritis [PSAGN]) has imposed temporal restrictions and, as most commonly used by the clinician, defines an almost characteristic clinicopathologic correlation. The term also implies certain distinctive features concerning etiology, pathogenesis, course, and prognosis.

Causes

Acute glomerulonephritis often occurs after a streptococcal infection, such as strep throat. When this is the cause, the condition is called acute poststreptococcal glomerulonephritis (APSGN), or postinfectious glomerulonephritis. It can also occur when certain toxins, such as paints or glues, are inhaled and then excreted through the urine. While chronic glomerulonephritis occurs as a symptom of certain diseases, its cause is not known.

Symptoms

Many people do not manifest any symptoms in the early stages of this disease. When symptoms do occur, they may include a low amount of urine or dark, bloody urine, fluid retention and tissue swelling (edema), such as a puffiness of the face and eyelids or swelling in the legs. Brain swelling and high blood pressure may produce headaches, visual disturbances and other serious brain disturbances.

Frequent sore throats and a history of streptococcal infection increase the risk of acquiring APSGN. Some of the main symptoms of APSGN include:

  • Fluid accumulation and tissue swelling ( edema ) initially in the face and around the eyes, later in the legs.
  • Dark brown urine.
  • Rash, especially over the buttocks and legs.
  • High blood pressure.
  • Increased breathing effort.
  • Fatigue.
  • Decreased urine output.
  • Pallor.
  • Lethargy.
  • Joint pain or stiffness.
  • Diarrhea.
  • Weight Loss.
  • Pale skin color.
  • Seizures.
  • Shortness of Breath and Rapid breathing.

Treatment

The main goal of any treatment is getting relief from the symptoms and prevent further complications. Vigorous supportive care includes bed rest, fluid and dietary sodium restrictions, and correction of electrolyte imbalances (possibly with dialysis, although this is seldom necessary).

Other Treatment Options for treating glomerulonephritis (ASPGN) may include:

  • Fluid Restriction.
  • For hypertension not controlled by diuretics, usually calcium channel blockers or angiotensin-converting enzyme inhibitors are useful. For malignant hypertension, intravenous nitroprusside or other parenteral agents are used.
  • decreased protein diet.
  • decreased salt and potassium diet.
  • Medications such as - diuretics, phosphate binders (medications to decrease the amount of the mineral phosphorus in the blood), immunosuppressive agents and some other blood pressure medications may be given to treat ASPGN.
  • Restricting physical activity is appropriate in the first few days of the illness but is unnecessary once the patient feels well.
  • dialysis - dialysis may be required for short term or long term therapy. Dialysis is a medical treatment to remove wastes and additional fluid from the blood after the kidneys have stopped functioning.
  • During the acute phase of the disease, restrict salt and water.
  • If significant edema or hypertension develops, administer diuretics.
  • Loop diuretics increase urinary output and consequently improve cardiovascular congestion and hypertension.
  • A renal biopsy is indicated for patients with rapidly progressive renal failure. If the biopsy findings show evidence of crescentic glomerulonephritis with more than 30% of the glomeruli involved, a short course of intravenous pulse steroid therapy is recommended (500 mg to 1 g/1.73 m 2 of methylprednisone qd for 3-5 d). However, no controlled clinical trials have evaluated such therapy.

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